EFFECT Best Practice Tool Kit by Kehittämiskeskus Oy Häme

European Union European Regional Development Fund

AIM and PURPOSE of EFFECT and BEST PRACTICE TOOL KIT

he aim of EFFECT is to further develop the multiproducer model in order to support European SMEs in providing higher quality and better customer orientation in well-being services for elderly people. The goal is to increase SMEs’ possibilities to utilise new business opportunities more effectively. The main focus in EFFECT is to develop and support fluent cooperation between different organisations, regions and even countries within Europe. To achieve these goals, the EFFECT project has increased cooperation by organising site visits and learning from each region’s best practices. The best thing in this cooperation model is that you don’t have to reinvent the wheel, you can learn from others. The demographic change and the challenge of ageing populations creates pressure on municipalities and entrepreneurs and third sector organisations to cooperate, and increase the quality of service and the contribution of preventive actions. EFFECT tries to endorse innovative and transferable approaches. The information on the future customer-oriented service needs of elderly people is valuable in terms of developing entrepreneurship promotion and disseminating best practices and innovative initiatives for well-being service companies. The ageing of the population is an opportunity. A growing number of elderly people in good condition are willing to use a variety of services. The aim of the survey was to explore future service needs in the region. Service needs are used to find tips and ideas which could help to create successful business opportunities. By combining best practices and experiences in the well-being branch from participating countries and survey results regarding future service needs, EFFECT is able to promote multiproducer model development through local actions. Each participant has its own theme: - Service procurement, purchase process (Umeå) - Housing, solidarity, fight against isolation, information and proximity, mobility and accessibility (Metz) - Development of service companies (Asturias) - Supported living at home (Brescia) - Enterprise approach (Lorraine) - Cooperation between public, private and third sectors (Häme). The themes will be introduced more deeply later on.

The collected best practices have been analysed according to EFFECT’s commonly agreed evaluation criteria. The reason for this toolkit is not only to discuss the whole best practice transfer from one region to another or from one organisation to another. Instead, by mixing the different elements of best practice approaches from the toolkit to the actual working environment within an organisation/ region, the ideal innovative approach can be achieved in the European public-private partnership model. All the collected experiences from participating regions will provide valuable information for the PPP-model and how the cooperation model and its parts work in the participating areas. EFFECT tries to identify examples of efficiency in the service production process via sharing experiences and best practice from different regions. In order to address the challenge of ageing people, we need well-being services to reach citizens more effectively. As a result of the EFFECT project, new information regarding senior citizens’ future service needs and best practice collection will be provided. All results will be disseminated regionally. This best practice toolkit can be used to modify European wellbeing services with regard to elderly people. The EFFECT project has been a good opportunity to lead participating regions towards higher levels of efficiency, internationalisation and profitability. It has enabled each region to benefit from the partnership. Although the challenge is the same, the actions differ. This means that we were able to transfer value-added information between regions and the solutions we found were optimised and fitted to the situation in each region. The aim of the project was to improve the public/private partnership in order to mutualise the efforts at the financial, human resource and other levels. EFFECT has offered up a valuable opportunity for participating regions to encounter other officials and entrepreneurs from different regions and create important cooperation partnerships or even friendships across Europe. As members of EFFECT, we hope to be able to support all kinds of cooperative work in order to face the challenge of an ageing population as effectively as possible. The ageing population can be seen as an opportunity and this is one step towards a brighter future.

INDEX 2

Aim and purpose of EFFECT and Best Practice Tool Kit

Evaluation criteria

Region and Participants

THEME 1. Development of service companies | Asturias, Spain

Best Practices 1. Health and Care College. Collected by Västerbotten.

Best Practices 2. Familiar Assistance Desk. Collected by Brescia.

Best Practices 3. Voutila center. Collected by Häme.

THEME 2. Supported living at home | Brescia, Italy

Best Practices 1. Housing affordability: developing an evaluation grid. Collected by Metz.

Best Practices 2. Preventive home visits among healthy older people. Collected by Västerbotten.

Best Practices 3. Senior Card (pass senior). Collected by Metz

THEME 3. Cooperation between public, private and third sector | Häme, Finland

Best Practices 1. Enforcement of the Act on System of Choice in the Public Sector (LOV) into the area of home care services. Collected by Västerbotten.

Best Practices 2. Breaking down distances. Collected by Asturias.

Best Practices 3. Heat-Health Watch Warning. Collected by Brescia.

THEME 4. Enterprise approach | Lorraine, France

Best Practices 1. Innovation activities in day centres (LOV) into the area of home care services. Collected by Asturias.

Best Practices 2. Keinusaari Senior Campus. Collected by Häme.

Best Practices 3. Innovation Gateway/Innovationssluss Västerbotten. Collected by Västerbotten.

THEME 5. Housing, solidarity, fight against isolation, information and proximity, mobility and accessibility | Metz, France

Best Practices 1. Welcome in - social meeting spot and cafe for adults and senior citizens in Umeå. Collected by Västerbotten.

Best Practices 2. Well-planned quality housing research. Collected by Häme.

Best Practices 3. BIRD - Small protected houses. Collected by Brescia.

THEME 6. Service procurement, purchase process | Umeå, Sweden

Best Practices 1. Best practice guides care homes for elderly. Collected by Asturias.

Best Practices 2. Pension Insurance Welfare Services, tailor-made action plan (CARSAT NORD EST). Collected by Lorraine.

Best Practices 3. Well-being cluster in Hämeenlinna and Forssa region. Collected by Häme.

EFFECT common conclusion

Acknowledgements and contacts

EFFECT Project group

E VALUATI ON CR I TER I A

Evaluation criteria Transferability

Short-term effects

Transferability refers to the possibilities of using an existing practice and to apply it in a new location, situation, environment or configuration. The possibility can be graded on a scale between “hard to implement” and “easy to implement”. Factors that affect the possibility to implement a certain best practice are the need for new methods, environmental factors such as legislation and regulations and readiness for change within the organisation. The transfer of best practices demands changes in performance, communication and behaviour. The source and the recipient must work together on teaching and learning, and improving the process in order to adopt it to the new setting. Regions and organisations that have an environment which facilitates the transfer of best practices are more likely to succeed. Critical points for an effective best practice transfer can be as follows: a common goal that links the best practice to the organisation/region’s objectives; good communication within the region/organisation; a clear definition of business needs and the importance of new working methods/best practice; an environment that encourages sharing and dissemination; a proper IT structure within the region, and the relationship between data, people and practice.

The short-term effects are mainly to do with the expectations of benefit in the short-term and are often related to cost advantage. Short-term effects can be positive or negative. When analysing the short-term effects we must be careful with regard to perceptions that might influence the effectiveness of best practice adaptation, and the risks associated with adaptation of best practice must be observed. The differentiation advantage of best practice should also be analysed as a short-term effect. This factor could outweigh the short-term cost efficiency depending on the region/organisation, timing and other relevant factors. In well-being services, public authorities must simultaneously protect the statutory service and keep costs low. Short-term cost savings and external or internal pressure from the public or political governance might shorten the planning horizon. The ability to benefit from the early timing “best practice” might also be affected by the organisation’s capability to process innovation and implementation. The ability to quickly adopt new ideas and put them into action can be seen as best practice in itself – this could render new energy and capability for a flexible and innovative organisation.

Guiding questions: • What kind of benefits and importance would the selected best practice bring to your region? What problem/need would the best practice answer to? • Is the best practice best transferred to private entrepreneurs, or is a public authority more suitable? • How exchangeable is the selected best practice according to the accomplishments or experiences made by the source of the best practice? • Are there some elements of best practice that are especially easily transferred to your region? Region excellence, etc. that could strengthen the adaptation to the best practice? • What environmental conditions of the region could affect the transfer of the best practice? Legislation/regulations? Timing? Control variables? • How could private entrepreneurs in the region benefit from the best practice? • Is there a possibility to reflect the region’s experience and expertise in the selected best practice? How do you determine transferable skills in your region? • What things should not be transferred from the best practice and why? • What kind of changes would be needed in the daily processes? • Is the region/organisation ready for the change?

Guiding questions • What kind of short-term effects would the selected best practice have in your region/organisation? Cost advantage? New possibilities? • How could private entrepreneurs in the region benefit from the best practice from a short-term perspective? • What kinds of short-term side effects might the best practice bring? • What kinds of risks in a short-term perspective are involved when adapting to the best practice? • Would the best practice bring some differentiation advantage to the region? What kind of short-term differentiation possibilities would there be? • If there are clear differentiation advantages, is the region/ organisation ready to gain differentiation advantage from the best practice, and how will this be done? • Does the region/organisation have enough resources and capabilities in the short term? • Does the region/organisation have a large enough trained workforce available within a short period of time? • What kind of complementary assets might this best practice bring to the region from public, private and third sector point of view? • What kind of capabilities does the region have to capture the benefits associated with the particular best practice in the short term? • Is the region able to benefit from early timing of adopting a best practice?

E VALUATI ON CR I TER I A

Long-term effects The long-term effects are mainly to do with the strategic planning process within a region/organisation. The strategic management approach is important in this implementation issue. Strategies contribute to competitiveness, which is one reason for a best practice transfer. The long-term perspective allows for the region to risk some negative short-term effects in order to gain more in the long run, whether that be cost efficiency or other differentiation advantages. Strategy documents and international/national/regional political tendencies are useful guides to sustainability and long-term effect. Guiding questions • Is the best practice in line with the region’s long-term strategies? What kind of attention needs to be paid to ensure that the long-term effects will stay in line with the strategies? • How could private entrepreneurs in the region benefit from the best practice in a long-term perspective? • What kind of long-term effects would the selected best practice have in your region/organisation? Cost advantage? New possibilities? • What kind of long-term side effects might the best practice bring? • What kinds of risks in a long-term perspective are involved when adapting to the best practice? • Would the best practice bring some differentiation advantage to the region? What kind of long-term differentiation possibilities would that be? • If there are clear differentiation advantages, is the region/ organisation ready to gain long-term differentiation advantage from the best practice, and how will this be done? • How will the region/organisation provide enough resources and capabilities to adapt to the best practice in the longterm? • What kind of complementary assets might this best practice bring to the region from the public, private and third sector point of view? • What kind of capabilities does the region have to capture the benefits associated with the particular best practice in the long term?

Cost effectiveness The adaptation of a best practice must bring added value to the region or organisation. A cost advantage can be a result of adopting a best practice that focuses on the specific region’s needs or strategic decisions. To gain cost efficiency, the region/ organisation might have to redesign or adjust working methods and processes within the region/organisation. Process-focused best practices can create savings faster than best practices that are not focused on processes. It is, however, important to analyse the existing processes within the region/organisation in order for the best practice to trigger the

intended positive effects. Cost advantage depends on surrounding factors, such as international/national legislation and regulations, competencies available within the region/organisation, and possibilities for cooperation between different actors. Guiding questions • Would the selected best practice lower the costs in your region/organisation? Which costs? • If there is no cost reduction as a result of the adaptation of the best practice, is there some other competitive advantage which has added value for the region/organisation? • What kind of investments must be made in order for the best practice to be implemented? • Do the regional companies and private entrepreneurs have the resources and capabilities which allow them to benefit from the profits associated with the positive outcomes of the selected best practice? • Do the legislations and regulations support the possibility to gain cost efficiency with the adaptation to the best practice? Is there a need for adjustments in the best practice implementation in order to be cost effective in the specific regional setting? • Do analyses of the current processes enable an adaptation to a process-focused best practice? What needs to be done in order for the new process to trigger the intended positive effects? • How does the short-term cost effectiveness relate to the long-term cost effectiveness? Are the short-term cost effects sustainable from a long-term perspective? Does the best practice have more costs in the short term that the amount of invested money it will eventually pay back in the long term?

Possibilities for innovative initiatives The possibility of gaining advantages that differentiates a private or public organisation from others within the same sector is one reason to adopt a certain best practice. Short- and long-term effects and cost effectiveness are different values that need to be analysed, but there is yet another value that can make the best practice transfer worthwhile: the opportunity to be first in the segment. An innovative initiative could be a new business idea; a new area of competencies; or a new product that would set the region/organisation ahead of others within the same field of expertise. For private entrepreneurs, these possibilities can be of interest when it comes to getting established in a competitive market, while public authorities and regions could benefit from innovative initiatives as a forerunner and a positive example that would generate interest and higher tax revenues due to a larger population. Guiding questions • Does the best practice provide any competitive advantages? • Does the best practice open up new business ideas that regional private entrepreneurs could benefit from? • Does the best practice give opportunities for innovative products or services that haven’t yet reached the region? • Does the implementation of the best practice imply that a new area of competence is needed within the region? How will this need be addressed?

REGI ON AND PAR TI CI PANTS

Region and Participants ASTURIAS | Spain Oviedo Chamber of Commerce The Oviedo Chamber of Commerce, founded in 1889, is a corporation set up under public law to work with public administrations and as a consultative body. Nowadays, Spain has 88 Official Chambers of Commerce, with their main objectives being the representation, promotion and defence of the interests of commerce, industry and navigation, and its main activities are focused on offering general services to SMEs, in particular training and support to foster foreign trade, internationalisation, business creation and advice, tourism, industry and cooperation. The Oviedo Chamber is located in the Principality of Asturias, with an area of 10,603.57 square kilometres and a population of 1,081,487 inhabitants in 2011. Asturias is located in the north of Spain. The Oviedo Chamber of Commerce represents the interests of over 55,000 businesses in 69 municipalities in Asturias. Its main services are focused on information and management resources, vocational training, company creation, company services and internationalisation. The Institution has lengthy experience in international undertakings, having managed and

implemented more than 50 EU projects. The Oviedo Chamber has fluent and very fruitful relationships with the regional authorities and usually works in cooperation, implementing programmes aimed at supporting business and entrepreneurship. In fact, the Chamber is legally linked to the Industry Regional Minister. Concerning older people, according to the data of the 2011 Municipal Register, more than 22% of the Asturias’ population is over 65 years old, and this rate increases to 43.93% if we include the population aged over 50. In analysing these figures, we can conclude that the demand for products and services for older people is certain to increase, and will represent important business opportunities for companies and new entrepreneurs.

BRESCIA | Italy Commune of Brescia and its ageing population Brescia is a city and commune in the Lombardy region of northern Italy. It is situated at the foot of the Alps, between the Mella and the Naviglio, with a population of around 197,000. It is the second largest city in Lombardy, after the capital, Milan. The city is the administrative capital of the Province of Brescia, one of the largest in Italy, with about 1,200,000 inhabitants. From 2003 on, the number of elderly people in the territory of Brescia has been constantly growing: 2010 saw an increase of +415 elderly people (+0.7%) in comparison to the previous year, reaching a total figure of 58,273 at the end of September.

Graphic 1 – Ageing trends in Brescia (2000-2010)

Looking at age categories, a consistent growth can be observed over the whole period 2000-2010, particularly in terms of those aged over 75, who represented 35.5% of the entire population in 2000 and 39.6% in 2010. Those over 80 increased even more, growing from 10,728 in 2000 to 13,835 in 2009 (+ 3,107). These figures clearly represent the dimension of the challenge that Commune of Brescia is faced with. Given this context, Commune of Brescia’s initiatives in the field of active ageing are designed with the specific aim of allowing elderly people to participate in society according to their needs, desires and capabilities, while providing them with adequate protection, security and care when they need assistance. In this framework, Commune of Brescia promoted many initiatives in order to increase the quality of life of its ageing population, and these can be divided into three main categories: 1) Self-sufficient elderly people: • Promotion of and support for the creation of voluntary associations for elderly people • Promotion of jobs for retired people: parks surveillance, traffic regulation • Promotion of recreational and cultural activities and social events 2) Partially self-sufficient elderly people: • Supported living at home (home services, alarm systems, meal deliveries, laundry services) • Supporting families through the creation of specific help desks • Care operator structures and individual services

REGI ON AND PAR TI CI PANTS

Tab. 1 – Elderly people in Brescia from 2000 to 2010. Distribution in age categories Year 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 100 E+ TOTAL 2000 13009 12653 11920 9973 5297 3816 1346 248 21 58283 2003 12990 11843 10627 8532 5931 2995 1391 280 21 54610 2006 11923 12456 10366 9242 6898 3444 1566 410 57 56362 2008 12343 12075 10853 9237 7098 4277 1442 471 62 57858 2010 12314 11706 11221 9232 7299 4565 1407 495 69 58308

The number of people aged over 75 constantly grew, from 20,701 in 2000 to 22,944 at the end of September 2010.

• Housing, solidarity, fighting against isolation with “family houses” 3) Non self-sufficient elderly people: • Creation of a local database for individuals with severe impairment that does not allow for independent living or assisted living in “family houses” Through its concrete support of the initiatives implemented in its territory, Commuune of Brescia’s commitment to the field of active ageing is to help elderly people stay healthy and active. Therefore, its vision is to invest in opportunities and services for seniors as well as to investigate new solutions to support them but also with the view of seeing them as full citizens and a resource for society.

COMUNE DI BRESCIA

HÄME | Finland Häme Region

Häme is one of Finland’s historical provinces, situated in southern Finland in the vicinity of large urban centres, one hour from the capital, Helsinki. The 16 municipalities of the region are divided into three sub-regions, those of Hämeenlinna, Forssa and Riihimäki. The Hämeenlinna subregion includes the city of Hämeenlinna and the two surrounding municipalities of Hattula and Janakkala. The Häme region comprises small and medium-sized towns and villages and the network formed by the services provided by them. The oldest inhabited inland areas in Finland can be found in the Häme region. Various lively events are an essential part of the culture of Häme. The region has long traditions in the fields of textile and glass design. The countryside in the Häme region has remained vital and dynamic and provides an excellent opportunity to familiarise oneself with the Finnish nature. Here, the nature is rich and versatile. The change of the seasons can be felt everywhere. There are about 175,000 people resident in Häme. The percentage of older people (65+) has grown slowly in recent years. Today the amount of those aged 65+ is about 20% of the region’s population. It has been forecasted that the amount of 75 to 79-year-olds and those over 90 will rise over the next ten years, while the 80 to 90 age group is predicted to actually decrease over the next decade. From 2015 onwards, all groups of older people will grow. The growth in the number of those aged 90 and over increases the pressure on around the clock care in Hämeenlinna in particular. On average, around 35% of 90 to 95-year-olds already need around-the-clock care. The aim of the older people’s services in the City of Hämeenlinna is to enable safe independent living for as long as possible. Hämeenlinna is using a multiproducer model to provide services for older people. Hämeenlinna has very heavy service structure, with two-thirds of the net cost used for around-the-clock care and one-third on living at home support services. Hämeenlinna wants to strengthen the role of families and organisations in securing the well-being of

older people. The cooperation between the volunteer organisation Pysäkki and the City of Hämeenlinna is very good. Häme Development Centre Ltd

Häme Development Centre Ltd is a business and economic development company in the Hämeenlinna Region, in the province of Southern Finland. The mission of the company is to make the region an attractive area in which to live and do business. Häme Development Centre develops and improves the region’s entrepreneurial and competitive climate. To achieve this goal, it works in close and open-minded cooperation with regional companies, business organisations, educational institutions, municipalities and third-sector agencies. Häme Development Centre provides a full range of business services. Business developers serve entrepreneurs in various situations. Their range of services include providing consultation concerning financing, premises or ownership exchange situations, or helping businesses to network with suitable partners. Different development projects, such as the Effect Project, are a part of Häme Development Centre’s tasks that aim to enhance, develop and execute the regional economic policy. The purpose of the projects is to create new industries in the region, to develop the operations and the competitiveness of the enterprises, to create new jobs and to enhance entrepreneurship, networking and marketing.

REGI ON AND PAR TI CI PANTS

LORRAINE | France Lorraine Region The Lorraine region, located in the north-east of France, is the only French region that shares borders with three countries: Belgium, Germany and Luxembourg. Consequently, Lorraine and her border partners have developed strong cooperation in a structured area called the “Great Region” (11.2 million inhabitants, with more than 196,000 people working in a different region). There are some 2,337 towns in Lorraine and the two most populated cities are Nancy and Metz. Lorraine’s mediumsized towns provide a pleasant lifestyle without the hassle of big cities. With 3,000 years of history, Lorraine has a rich heritage, and is very attractive with its numerous monuments, museums, military sites and art industries, such as the manufacture of string instruments, crystal and embroidery. It also has a long-standing and deep-rooted cultural tradition, developed by sectors including music, theatre and dance. There are 2.3 million inhabitants in Lorraine, which is about 4% of total population of France. Almost 25% of Lorraine inhabitants are under 20 years old, but the population keeps ageing due to increasing life expectancy and a drop in the birth rate. This trend, which corresponds to those in the rest of France and across Europe, as well as demographic imbalances (between the central area and the rest of the region) and a weak net migratory rate, generate problems that are at the heart of the CREATOR programme.

ances, weak net migratory rate). Lorraine is one of the top five regions in the country for which ageing will be the most marked. The region will continue to see an acceleration of the ageing population and especially a significant decrease in the number of young people. As the regional authority, the Regional Council of Lorraine is acting with numerous legal competencies, among which many have direct links with demographic issues (economic development, education and training, professional integration, land planning). The president of the regional council is in charge of public activity and needs to anticipate the future evolution of the population in order to make essential decisions relating to the field of health, and in particular on the services addressed to older people. By participating in CREATOR, the Lorraine Region wishes to improve regional policies in relation to demographic challenges and to learn more from new models and strategies thanks to best practice developed by partner regions or EU experiences. Moreover, Lorraine also functions in the capacity of sharing interesting experiences such as tools dedicated to demographic challenges that target groups, such as a financial tool that is used to encourage the development of new services and the creation of SMEs, or the use of ICT in delivering new services.

Regional Council of Lorraine As stated above, demographic challenges have a huge importance for Lorraine (ageing population, demographic imbal-

METZ | France The City of Metz

Centre Communal d’Action Sociale (CCAS) of METZ

Metz, France’s 29th largest city, is the capital of the Lorraine region, situated in the east of France, close to the borders of Belgium, Luxembourg and Germany. There are 121,841 inhabitants. According to 2009 statistics, 18.4% of people are aged 60 or over. Metz has a lower elderly population than many other cities of a similar size. In France, the share of those aged 60 and above is 22.6%. The population of older people will increase further in the coming decades:

CCAS of Metz is a local public agency run by a governing body presided over by the mayor and is composed of town councillors and representatives of associations working for elderly or disabled people or social inclusion. The total annual budget is about 22 million EUR. The city’s social policy targeted at the elderly is the responsibility of the CCAS with associative and institutional local partners, and it attempts to provide answers to issues related to ageing by: • Promoting the position of older people in the city • Informing and giving direction to senior citizens and their relatives • Fighting against isolation • Proposing housing suited to the circumstances • Strengthening solidarity between the generations

60 and over Number Proportion 75 and over Number Proportion

2009 2020 2030 22,390 27.284 29,594 18.4 23.3 25.8 8,688 9,400 12,862 7.1 8 11.2

92.5% of the population aged 60 or over live at home or in retirement houses for independent people.

The city of Metz gained the French label “Bien vieillir-vivre ensemble” (“Getting older healthily – living together”) in 2010 and was accepted as a member of the World Health Organization’s Global Network of Age-friendly Cities and Communities in 2012.

REGI ON AND PAR TI CI PANTS

CCAS of Metz: • Manages six retirement homes for independent people (276 flats) • Leads a partnership with 25 senior clubs (about 1,800 members) • Disseminates information to older people and their relatives (senior citizen’s guidebook and website www.ccas-metz.fr ) • Fights against isolation: freephone helpline for reporting situations of isolated older people with difficulties/ social accompaniment for isolated older people. • Organises an annual seminar “Assises seniors dans la cite” to discuss the evolution of society and to debate the needs of the elderly people with the senior citizens themselves, elected members and professionals in the care sectors. • Makes a call for proposals for innovative projects to support older people. • Concluded a charter of 10 commitments in 2010 with several partners for “Getting older healthily – living together in Metz”.

UMEÅ | Sweden The county of Västerbotten

Umeå municipality

Västerbotten is the second largest county in Sweden and is about one-eighth of the country’s total land area. One of the county’s greatest assets is its nature and the resources that spring from it. The county seat is Umeå, the largest city north of the Stockholm-Uppsala region. Umeå has a population of 116,465, while the region has a population of 259,667 (2011). Umeå municipality is one of 15 municipalities within the county. As in many other regions in Europe, Västerbotten has an ageing population and the prognosis suggests that the proportion of people aged 65 years and above will increase over the coming decades. The percentage of the population aged 65 years and older is lower in Umeå than in the region as a whole as well as in Sweden.

Umeå municipality is governed by elected politicians with responsibilities for social services; the school system; planning and building issues; health and environmental protection; waste management; refuse and street cleaning; water and sewage; emergency and rescue services; contingency planning and safety; chief guardian/public trustee services; recreation and leisure activities; cultural services and energy operations. The political organisation is supported by a civil organisation within the municipality. Care of the elderly is managed by the social welfare services and includes different services in the home of the elderly and in special accommodation. Umeå municipality arranges for a total of 17,089 hours of home care services per week provided by private and public agencies. Approximately 30% of the hours are performed by private home care service providers.

Age distribution (2011) Age Umeå 0-17 19.4% 18-64 65.7% 65-79 11.1% 80+ 3.8%

Västerbotten Sweden 19.3% 20.2% 61.2% 60.9% 14.1% 13.6% 5.4% 5.3%

1 Theme 1.

Development of service companies Asturias, Spain

T HEM E 1 . | D EVEL OP M ENT OF SER VI CE COMPANI ES | ASTUR I AS, SPAI N

Description of the theme

n increasingly ageing population is a fact all over Europe, and neither Spain nor Asturias is an exception. In our region, 43% of the inhabitants are over 50 years old. This fact, added to the change in the care model for elderly people, constitutes a new demand for products and services. Services focused on elderly people can be provided directly by the public sector, subcontracted to private companies or contracted directly by users to companies. According to this situation and the changes in the sector, the development of new ideas for products and services is necessary in order to cover the needs that derive from an ageing population. The Oviedo Chamber of Commerce, with the

aim of developing the well-being sector in Asturias from the business perspective, is participating in the Effect project in order to identify business ideas and opportunities for companies and new entrepreneurs. The process developed during implementation of the Effect programme has been to analyse different products and services provided by the private sector in other countries, in order to import new business ideas in our region. Close contact and coordination with the Social Affairs Ministry in our region, as well as our experience and contact with companies and entrepreneurs, has helped us identify and establish best practice approaches related to new business opportunities.

BEST PRACTICES 1. Collected by Västerbotten Health and Care College The shift in generations will result in a lack of skilled workforce by 2015 – 2020. Over 20% of the workforce will retire within the next 10 years. The demand for staff in health and social care with upper secondary level qualifications is significant. More young people and adults, both men and women, are needed in health and social care. Regional focus - effective use of resources. From 2012 - 2020 the region will have to employ 500 trained nurses/nursing staff each year. The objective of this best practice is collaboration in education and training in health care that creates a structure for learning in cooperation with the working life at regional and local levels. The overall objective is: (1) to offer students an attractive education programme that can lead directly to a job or provide a good basis for further studies; (2) to contribute to securing health and welfare oriented activities/business needs of skilled staff; (3) to provide efficient use of resources through collaboration. The aim is to secure the supply of skilled staff, increase interest in health and social care education, offer attractive and quality practical training, increase cooperation between health care education and care providers, to enable the validation of work experience, and promote careers in health and social care services. Through cooperation and mutual planning, the health and care receivers, employees, employers, students and the providers of education can gain strategic as well as immediate advantages. Main stakeholders: National initiative promoted by the Swedish Association of Local Authorities and Regions (SKL), the Association of Private Care Providers (Vårdföretagarna) and the Swedish Municipal Workers’ Union (Kommunal). Regional implementation by the region of Västerbotten in cooperation with eight municipalities. Representatives from health and care providers (public and private actors), providers of education at upper secondary and adult education levels (public and private), Umeå University, trade unions and the municipal employment

office participate at different levels. The Västerbotten region finances 50% of the costs, and the municipalities with health and care education split the rest (Örnsköldsvik, Vännäs, Robertsfors, Skellefteå, Umeå, Norsjö, Vilhelmina and Lycksele). A great deal of work has been done on developing advanced education packages based on the new high school plan that was taken into force in autumn 2011. An inventory of needs within the county council and municipalities was made and resulted in two professional care management training programmes, a dementia specialist nurse and dental nurse. These courses are popular choices among the students in the region. The challenge to employ about 8,900 people in the health and care professions by 2020 will be adopted through broad regional collaboration aiming at increase the attractiveness of the health care profession so that young people and adults choose to study in the field. The health and care college will work to achieve the regional and local objectives, and develop them to further strengthen the profession’s attractiveness. EVALUATION Transferability The Spanish education system is regulated by different laws that determine the curricula of each degree and the professionals and institutions in charge of teaching it. However, the creation of a consortium that promotes solutions for educational needs and creates synergies in order to develop a common solution for staff needs is an example to take into account, and could be transferred to other sectors of activity. Short-term effects

T HEM E 1 . | D EVEL OPM ENT OF SER VI CE COMPANI ES | ASTUR I AS, SPAI N

One of the principal short-term benefits is the creation of synergies with other entities. These synergies are provided by the common learning outcomes of the cooperation and the

contributions of know-how created for each stakeholder part of this project. Another is the possibility to train people based on the real training needs, and consequently to create a programme with the qualifications needed to develop the different working places. Long-term effects The principal long-term effect is to consolidate a training programme and a solid network, based on a real need and direct contact with the labour market. This situation will provide the opportunity to answer future needs that could appear in terms of training and qualifications in the sector. Furthermore, the outcomes of this experience â&#x20AC;&#x201C; the collaboration between entities and stakeholders â&#x20AC;&#x201C; could favour the creation of new and similar initiatives. Cost effectiveness The effectiveness of this initiative is, from our perspective, significant, because it has the possibility to answer a clear demand from all the different stakeholders. However, the creation of collaborations and links between entitiesas well as stakeholders for the training programme developmentis low cost and the final result is highly effective. Possibilities for innovative initiatives The methodology developed for common work between the various actors from the different sectors involved in a professional reality is highly innovative. This process and methodology has resulted in the creation of a training programme in response to the needs and requests detected.

BEST PRACTICES 2. Collected by Brescia Familiar Assistance Desk The familiar Assistance Desk has been created in order to select service companies able to provide assistance in the homes of elderly people in the territory of Brescia, meeting the increasing demand for assistance (due to demographic changes) and the offer of service companies working in the field of health and care. Service companies have been identified in the territory in order to provide those care services at home that the municipality could not implement autonomously. Selected according to public procurement rules, the service companies had to prove the internal expertise provided by their professionals (care operators, social assistance, nurses); the increasing demand of home care assistance from elderly people also contributed to the development of new service companies in the territory and a decrease in undeclared workers, especially self-employed ones. The experience was very fruitful. Service companies have increased in number and today the desk itself is managed by a service company. Families who live in the territory now have a concrete and cost-effective alternative to undeclared workers.

Short-term effects One short-term effect would be the possibility to offer a service to users with all the information related to companies, detailing the services provided and the endorsement of public bodies. This fact will provide credibility and impartiality. For companies, being part of this Desk will be a direct platform from which to offer their services to all potential users and customers. Long-term effects A long-term benefit would be the official approval of more companies on the Desk. Consequently, it is mandatory to adhere to the standards indicated by the administration in order to be included on the system. This rule will remove unqualified actors from the profession as well as any service providers that do not adhere to the rules or the relevant legislation.

EVALUATION

Cost effectiveness It is complex to determine the cost for the creation of this tool and the process for companiesâ&#x20AC;&#x2122; assessment.

Transferability The idea to create a desk with companies that offer Services for Assistance at Home is of great interest for all the regions that do not have it already. Currently, there is no single directory that contains all the service providers endorsed by a public administration or public body in our region. The Familiar Assistance Desk will be of benefit to both companies and users, and its transferability is simple and easily adapted to other interested regions.

Possibilities for innovative initiatives This tool is highly innovative for our region, because no similar tool or Desk exists for companies, although a register of services provided directly to dependent people does exist. Moreover, it is an initiative that could increase the creation of new companies and the professionalisation of some companies that already exist.

T HEM E 1 . | D EVEL OP M ENT OF SER VI CE COMPANI ES | ASTUR I AS, SPAI N

BEST PRACTICES 3. Collected by Häme Voutila center The Voutila Centre offers a wide range of services for older people in Hämeenlinna. The aim of the centre is to arrange services and activity, which supports and promotes the customer’s functional ability. The Voutila Centre began operations in November 2006. It offers a wide range of services for older people. The centre has three old people’s home departments, with a total of 149 longterm residents and short-term customers. The Voutila Centre also organises outpatient services, designed to support older people to live independently as long as possible. The service centre is a low-threshold operation for self-reliant and active seniors. Those who need more help and support and those with memory lapses are signposted to daytime groups. The Voutila Centre’s goal is to arrange services and activities that support and encourage customers to act. It has group and mixed use places, and a swimming pool and gym that customers and residents can use with the guidance of the staff. The Voutila Centre has two physiotherapists. The physiotherapist from outpatient services is responsible for daytime group customers’ rehabilitation but also for open and specific physiotherapy groups targeted at elderly people. The physiotherapist is accompanied in a multi-professional network in which their objective is to develop a rehabilitation path for elderly people, for example. The physiotherapist from the assisted living facility is responsible for the rehabilitation of customers who live in residential homes or those who are temporary customers. He/she supports functional maintenance in working habits in different departments. In addition to the gym and swimming pool, there is also a dining room, a hobby room, a music room, a fireplace room, a conference room and a chapel. Other features include hairdresser, beautician and massage businesses and a nursery. Out of office hours, the gym and swimming pool may be rented out to companies, associations or other agencies. Voluntary work is highly appreciated in the delivery of outdoor activities or alongside different events. The Voutila Centre is an entirety in which all actors support

each other and because of that, it can offer elderly people good quality service in one package. EVALUATION Transferability In the Asturias region, there are residential centres for elderly people that are public, private and privately subcontracted by the public administration. Although these centres do not follow the Voutila system, different centres exist that offer the same services, but not in the same building. Consequently, it is an initiative with limited transferability for our region, but it could be a business opportunity for a private company that could create a new centre or add services to an existing centre. Short-term effects In the short term, there is no real benefit for society because all the services are already provided by other public entities or by private entities subcontracted by public administration. Long-term effects A long-term benefit is the possibility to offer different services in an integrated way that nowadays are provided separately. Cost effectiveness It is difficult to predict the cost of effectiveness of adding new services into existing centres and the suppression of services provided by centres that currently provide them. For this reason, it will be necessary to identify the real value of the cost and effectiveness before commencing any change of activity. Possibilities for innovative initiatives The innovative approach could be included in the business model selected in order to render the services.

2 Theme 2.

Supported living at home Brescia, Italy

T HEM E 2 . | SU P P OR TED LI VI NG AT HOME | B R ESCI A, I TALY

Description of the theme

upporting living at home includes all those actions that aim to allow or facilitate elderly people to remain in their living environment. Living at home implies maintaining the connection with daily habits, personal relations, culture, and history. Therefore, remaining at home does not mean simply receiving assistance, but also preserving relationships and social contacts within the community. Therefore, supporting living at home also implies the role of the responsibility of the community towards elderly people living within it. Supporting living at home usually includes a system of services responding to both socio-

emotional and healthcare needs, taking a mix of subjects into account: the family, the operators, the living community (e.g. neighbourhood or citizens associations). To do so it is necessary to establish an integrated intervention that must include the resources of the person, his/her family, his/her social context and the operative capacity of the operators. Supporting living at home demands that the local actor adopts a role of governance over the whole intervention, a capacity to establish publicprivate partnerships, and to respond to both social and medical needs of the elderly people who need to be supported to live at home.

BEST PRACTICES 1. Collected by Metz Housing affordability: developing an evaluation grid The aim of the practice is to reserve and allocate accessible accommodation for ageing and disabled people in a part of the social housing sector of the city. To evaluate the affordability of the accommodation in a part of the social housing sector of the city in order to identify that which is accessible to ageing and disabled people, a working group has developed an evaluation grid. The working group is composed of members of associations that represent disabled people, the municipal service for disability, and the CCAS (representing older people).The working group met five times between October 2010 and May 2011. The evaluation grid was developed in June 2011 and was tested by the members of the working group. Following these tests, the grid was adapted. The working group developed the grid by using grids created by other French collectives. One of the problems was deciding between a very specific grid, which was difficult to use (in that producing usable results was complex) and a less precise but much simpler grid. The tests were made for verifying the usability of the grid, after which the grid was adapted. The exchanges and the work carried out in this group have been very rich. Two people will be recruited to evaluate the affordability of 700 flats in the social housing sector of the city, using this grid. Lessons will only be learnt by implementing the practice. EVALUATION Transferability The local administration of Brescia owns around 2,500 premises to be assigned by public announcement. In these days, most requests for council accommodation come from families with children, but unfortunately there is a lack of appropriate accommodation in the existing public stock. A large share of these 2,500 houses are occupied by old people. Houses are now oversized for its single occupant,

because they have been assigned many years ago, when their families were large and their levels of independence were different. With regard to this, there are two kinds of problem: 1. even if the size of the house fits the standard fixed by local law, it could still be inadequate because of accessibility issues (i.e. absence of elevators, doors too narrow for a wheelchair, etc.) 2. oversized houses involve significant expenditure (i.e. rent, maintenance, heating, waste charges, etc.) Short-term effects The proposal of consensual house moves, preferably in the same neighbourhood where the older person lives, or alternatively nearer to his/her family achieves two results: • to assign adequate accommodation to people who can no longer live independently • to allocate large houses to large families Long-term effects The continued monitoring of the existing public stock leads to: • accommodation more suited to life’s cycle (couples, couples with children, single people) This means a more rational management of public resources • lower expenditure and less financial assistance covering of meeting the expenses related to inappropriately large accommodation. Cost effectiveness To forecast economic help required for low-income families to relocate. Possibility for innovative initiatives With regard to the database and the personnel resources, this best practice approach is easily implementable.

T HEM E 2 . | SU P P OR TED LI VI NG AT HOME | B R ESCI A, I TALY

BEST PRACTICES 2. Collected by Umeå Preventive home visits among healthy older people Objectives of the best practice: • To prevent isolation • To identify risks and needs that can be addressed at an early stage. • To provide information about the help and support available from social and health services and NGOs (non-governmental organisations). • To plan for needs and future services • To engender cooperation between municipal elderly care and county council health care

EVALUATION

The main objective is to create security, promote health, support healthy lifestyles and thus postpone the need for regular care among healthy older adults. Civil servants from the municipalities and the county council contact all citizens at the age of 75 that haven’t previously been in contact with the social welfare services. Those who give their consent are visited in their home for an informal chat, are provided with information about social and health services and social activities and take part in a semistructured interview. The home visit takes between 1-1½ hours and has a common structure within the region of Västerbotten. The interview responses are registered on a communal web tool and the results are used by the municipalities and the county council to plan future needs and services. The participating stakeholders are Västerbotten County Council and municipalities within the county. The programme of preventive home visits was a trial activity that took place between 2006 - 2009. In 2010 the preventive home visits was founded as a common regional concept with a common manual and registration tool. Financing was provided by national stimulus funds (“Stimulansmedel”) from 2006 – 2011. In the past two years, the budget has covered the costs of 1.5 – 2.0 full-time employees at Umeå Municipality. From January 2012 the preventive home visits are financed via the annual municipal and county council budget. A doctoral thesis from 2009 suggests that preventive home visits could benefit older people, but to be successful it is important for the home visitor to be professional and to understand how the different coping strategies of older people work (Sahlén, K-G. “An ounce of prevention is worth a pound of cure”). The preventive home visits in Umeå prevent isolation and provide social companionship. The home visits have created a relationship between the social welfare services and individuals that haven’t been in regular contact with the municipality or the health care services. The home visits have supported awareness of the opportunities available, risk preventive work in the home environment, and have created a sense of security for those living independently. The results from the home visits are used as data for planning the future needs and activities within the municipal social welfare and the county council health care.

The fundamental target is to create the habit of what we define as ”a supportive closeness” in order to combat loneliness and isolation felt by vulnerable people whether they are old or young.

Transferability A project named “Nice Neighbourhood” has been operational in the city area since 2004. The project has the aim of placing institutional home care and a wide network of volunteers side by side. The network keeps an eye on the people who are at greater risk than the others in an emergency situation in order to - help them cope with the situation - alert the public services.

Initially, the project included the following work: Identification of the ”vulnerable older people” group – people who: • are 75 years old and over • live alone • are not dependent on social services • have no children living in the city area; Almost one hundred voluntary organisations worked to: • contact 5,000 selected older people and carried out an evaluation with regard to their social, health and housing situation. The level of vulnerability is defined by the consequent score • communicate to social services those cases of high vulnerability • monitor the situations of those medium and low vulnerability cases through follow-up visits. The contents of the best practice approach in Umeå suggest to us that we need to delve deeper into the medium vulnerability cases through visits from a qualified social worker. Short-term effects • Prompt detection of high-risk situations; • Identification of the right answer to the needs for institutional and informal (relatives, volunteers, etc.) services. Long-term effects • Mapping of the situation regarding the older population in Brescia and of the evolution of social and health issues • Adjusting the service offering and redefining social policy for older people • Optimising resource Cost effectiveness Insurance policy and expenses refunded to the amount of EUR 400 per worker per month. Possibility for innovative initiatives Arranging, in agreement with the university, traineeships and other opportunities for students from the Department of Social Policy and Intervention to work on the project. Issuing a public announcement for the civil services provided and granted by the regional government dedicated to those graduating from the Department of Social Policy and Intervention.

T HEM E 2 . | SU P P OR TED LI VI NG AT HOME | B R ESCI A, I TALY

BEST PRACTICES 3. Collected by Metz Senior Card (pass senior) The objective of the best practice is to create a Senior Card (Pass Senior) which will permit seniors to access leisure, culture and sports services and to benefit from discounts in shops and companies for goods or services. Workshops will be set up to: • set the limits on the benefits provided by the card: commercial discounts, special prices for public cultural facilities or leisure activities organised by associations • define how to negotiate with the private sector to obtain discounts - organise the communication about this new card, registration and how to deliver the cards. The Senior Card is successful because it will allow older people, especially those on a low income, to access cultural and leisure services, and to develop the purchasing power for this population. This practice will be evaluated regarding to the number of cards delivered at the beginning of the service, and then each year. Later it will be possible to carry out random sampling and work with the Senior Card holders to study how the card is used and analyse the behaviour of the companies involved in the scheme. EVALUATION Transferability The senior card, dedicated to the over 65s, is already available throughout the whole country under the name of “Silver Card”. It enables those aged 65 and over to access museums and public transport at reduced cost. It is possible to enlarge these benefits through agreements with: FOOD STORES By providing a selection of different shops in each neighbourhood, our target is:

1. To facilitate easier access 2. To improve and diversify older people’s diets CRAFTSMEN It is often difficult for older people to find help to carry out small home repairs. This might be due to: 1. financial issues 2. the fact that companies refuse to do small jobs 3. the fact that they are unable to evaluate whether the work done is worth the fee All this can lead to giving up on routine maintenance and to the poor condition of accommodation. HEATH AND SOCIAL SERVICE To provide those services regarding well-being which are not provided by the National Health Service. Short-term effects Increasing the purchasing power of older people. Creating a list of providers (plumbers, electricians, painters, hairdressers, podiatrists, etc.) who guarantee inexpensive, quick and qualified services. Long-term effects Enhancement of quality of life regarding the care of oneself, home maintenance and relationships. Cost effectiveness The Senior Card will be dedicated to those older people who are experiencing financial difficulties in order to give them the opportunity to purchase services more easily. The local administration could allocate an amount of EUR 20,000 to trial this intervention. Possibility for innovative initiatives This best practice approach could be a support to enterprise.

3 Theme 3.

Cooperation between public, private and third sector H채me, Finland

T H EM E 3 . |

COOP ERAT ION BET W EEN PUBLI C, PR I VATE AND THI R D SECTOR | HÄME, FI NLAND

Co-operation between public, private and third sector actors in well-being service production

hen faced with the future demographic challenge of the ageing population in Finland and in other parts of Europe, cooperation between different actors becomes more important. The challenge is the lack of resources. Municipalities can’t produce all services by themselves. Hämeenlinna municipality uses a multi-producer model. This means that municipality buys services from private well-being entrepreneurs whilst producing similar services itself. The system reduces the risk of well-being service production from a municipal point of view and offers up business opportunities to private entrepreneurs. The municipality retains expertise and implements the responsibility of organising well-being services by statute. Public-private partnership is an acceptable alternative to handling social and health services. The public-private partnership model helps the municipality to organise its services more effectively but the strategy must be long term. Both parties must be able to bargain on their own behalf and they must be committed to creating stable relationships among actors.

The cooperation aims to enable open and fair cooperation between the public, private and third sectors. This cooperation generates opportunities for the private and third sectors in public and statutory well-being service production. The importance of cooperation between different actors is stressed more than ever. Cooperation promotes the achievement of common goals and helps to commit to overcoming common challenges. Effectiveness and efficiency increases with this model. If the cooperation is used properly, it decreases the overload of actions, and time management and resource management are used efficiently to achieve more meaningful service production. Cooperation affords the opportunity for development and the effective use of resources. Cooperation must be in everyone’s interest. Improved cooperation between all sectors will cause improvements to public procurement related to wellbeing services, increased entrepreneurial activity in participating in well-being sector development, and improved cooperation by introducing actors to each other and to subcontracting chains. It helps to utilise synergy benefits.

BEST PRACTICES 1. Collected by Umeå Enforcement of the Act on System of Choice in the Public Sector into the area of home care services The topic of the best practice is to enable private actors to provide home care services within the municipality of Umeå in the same premises as public home care services. The main idea of the act is that all private actors that fulfill the special conditions of contract are available as care providers for people that have been granted home care services by the municipality. The national Act on System of Choice in the Public Sector was introduced with the purpose of empowering citizens, strengthening freedom of choice and influence by citizens as well as stimulating a variety of care providers within the fields of elderly care, care of people with disabilities and health care services. All private actors fulfilling the contract of special conditions are listed as available care providers for people that have been granted home care services. The care receiver independently chooses the care provider based on the information available from the municipality and the service providers. The care provider has 48 hours to set the service into effect. A care receiver has the possibility to change care provider at any time. The municipality has the responsibility to monitor and follow up on reports of

misconduct and breach of contract. The administration and implementation of freedom of choice within home care services are a joint commitment that requires good communication between the municipality and the home care providers as well as within the municipality. New routines and activities are under development to make this commitment even more secure and high quality for the end users. The national legislation was stipulated by the Government Office of Sweden. The choice of applying the Act to home care services was made by the municipal board. The administration and implementation of the Act is a joint effort by the Procurement and Purchase Office and the Social Welfare Services Office within Umeå municipality. The legislation was taken into effect on 1 January 2009. Umeå municipality, which has a long tradition of using a regulated system of choice, began with trials for private actors within home care services in 2003. In 2006 there were seven private actors – this number had increased to eleven by 2009. With the Act on System of Choice, ten private actors renewed their contracts according to the new legislation in 2009. Today, some

T H EM E 3 . |

COOPERAT ION BET W EEN PUB LI C, PR I VATE AND THI R D SECTOR | HÄME, FI NLAND

19 home care providers are active within the municipality, four of which are public and fifteen private actors. Cooperation among home care providers as well as between the municipality and the home care providers has been improved. Citizens that meet the criteria of home care receivers now enjoy freedom of choice and the possibility to change home care provider at any time. A variety of home care service companies have been established in Umeå in recent years and the number of home care providers is growing. Some important experiences to take into account is that some citizens have difficulties in choosing a care provider. Civil servants granting the home care services must be neutral in providing information to the care receivers and this has proven difficult at times. The administration of the implementation of the Act on System of Choice in the Public Sector demands routines and good cooperation within the municipality. EVALUATION Transferability The best practice system of choice is based on the position of customers, services and improved management. The aim is to give customers the opportunity to choose their place of treatment, equal access to these services and to improve the quality of care and patient safety. The customer-oriented approach is becoming more and more important in every country and the idea of customer-orientation is very easily transferable. Hämeenlinna municipality is planning to use service vouchers as part of their everyday activities in elderly care at the beginning of 2013. The service voucher is expected to improve the efficiency of services. The service voucher is also expected to ease and improve private entrepreneur business opportunities in Häme region. The service voucher system sets the municipality obligation to monitor the prices of service providers. Customer equality in access to services must be ensured by the service voucher value, and the customers’ self-financing share remains reasonable. The target is greater freedom of choice in elderly care services. Hämeenlinna currently uses the multi-producer model. It enables private entrepreneur participation in the well-being service production process in the Häme region after a tendering process. In this multi-producer model, the customer him or herself does not have the freedom to decide in which place she/ he will be taken care of. The ideal situation would be that public, private and third sector actor partnerships work fluently, that all the various parties are effective parts of this well-being service production chain, and the customer can decide where she/he wants to go and receive treatment or care. This would be a real system of choice. System of choice, a Swedish model, is interesting and transferable from one region to another. It is a step towards real customer orientation. Freedom of choice is the primary starting point for all services. Customer oriented outlook is the most important basis that should guide the measures. This best practice is directly transferable. Finland and Sweden have similar systems in elderly care. System of choice has already been tested in Sweden and it is working. There is a very good possibility to adapt this practice and the positive actions that are really working without a long testing process. A flexible cooperation structure is the most important thing. Short-term effects The system of choice would increase private entrepreneur and third sector actor business opportunities within the region. The customer-oriented approach is important for elderly people’s autonomy and it will increase elderly people’s quality of life. All

preventive work will help older people to remain independent as long as possible and that is a very important strategic goal here in Häme. Long-term effects To help elderly people to remain independent living at home as long as possible will have positive long-term effects and savings. The enhancement of the quality of life is important for all older people. In the long run, the system of choice will enhance private entrepreneur business opportunities and competition in well-being service production markets. This competition will increase the quality of services and force all partners (public, private and third sectors) to improve their services and efficiency. In the long run, all participants need to be innovative and customer-oriented because of that competition in the market. The choice is made based on the reputation of the service producer, the quality of service or the price. The range of services will expand because of the innovative approach of all parties. System of choice forces all participants to develop their services from the customer’s point of view, which will be the answer for future service needs and serve customer’s individual service needs in the future. Development is continuous. Diversification of service needs is responded to more effectively within the system of choice structure. Services will be diversified to meet actual demand, which means that some services might be eliminated in the future. This is a good thing because resources are used more effectively and supply and demand will genuinely meet. Cost effectiveness The practice is cost effective. When a customer can choose his/ her services, it forces municipalities and private entrepreneurs to improve their services to be more cost effective. Preventive actions are important and investment now can be saved in the future. Service needs will increase in the future because of the ageing population and the fact is that municipalities cannot produce everything themselves. When the service production has been decentralised, all participants can concentrate on their core business. Resources are used more effectively and supply and demand genuinely meet. Possibilities for innovative initiatives For private entrepreneurs providing well-being services, this system of choice is good news. It will boost many innovative initiatives in the field of well-being service production. This approach might help some private entrepreneurs to find their competitive advantage. When the system of choice is part of a municipality’s strategic decisions, it will enable private entrepreneurs to develop their business towards customer’s needs. This will also help private entrepreneurs’ long-term planning and investments.

T H EM E 3 . |

COOP ERAT ION BET W EEN PUBLI C, PR I VATE AND THI R D SECTOR | HÄME, FI NLAND

BEST PRACTICES 2. Collected by Asturias Breaking down distances The topic of this best practice is prevention of isolation and living independently in rural areas The best practice is called the Integral Care Programme and is designed for elderly people living in rural areas in the Principality of Asturias. The aim of the best practice is to avoid the geographical discrimination suffered by elderly people living in rural areas through a flexible intervention which offers services and opportunities adapted to their needs. Objectives of the programme • Providing suitable support to dependent elderly people in their home environment. • Get services closer to elderly people living in isolated areas with dispersed population. • Boosting the participation and integration of elderly people in the community (avoiding loneliness and isolation). Rural areas in Asturias have: • Population dispersion: scattered population centres. • Geographic isolation: complicated access due to orography. The principal needs of these people are: - Increasing dependence - Isolation and loneliness - Poor access to services

EVALUATION

Preventive actions are also seen as being very important in the Häme region and the purpose here is to provide and encourage older people to go out and visit day centres and boost their daily activities outside their own home. Häme region has a similar activity which is called “kirjakassi”, or bookbag. This bookbag activity is closely linked to the local library in Hämeenlinna. This means that library officials will first visit older people and find out what kind of literature each person is interested in. A work coaching foundation called Luotsi helps to deliver the books to the office of the home care services. The home care professional will then deliver the book bag to older people’s home, which will then be exchanged for new one once a month. In Finland, this kind of activity is not transferable as a whole. However, there is always a possibility to transfer parts of it. The challenges are different here in Häme to Asturias. The transfer wouldn’t require so many changes to current actions but the need for adaptation is not so obvious than it is in Asturias. The common goal in both regions is to help older people to remain at home as long as possible. In Finland, we only have a few mobile services like Mallu car in Etelä Karjala and Moppiili car in Hämeenlinna. Mallu car is a mobile service unit where the outpatient nurse/nurse services are exported to the province. Moppiili offers a similar service in the Häme region. These are new innovations in Finland, designed to break down distances. Volunteer work is coordinated by Pysäkki here in the Häme region. From Pysäkki you can ask for help and support for a variety of life situations.

Transferability Breaking down distances is about the prevention of isolation, which is seen as one of the most important parts of elderly care. The objective was to provide suitable support to dependent older people living in their home environment, to get services closer to elderly people living in isolated areas, and to boost the participation and integration of elderly people in the community.

Short-term effects Every new practice which helps older people to remain at home as long as possible has positive short-term effects. Häme has a bookbag service, as mentioned above, and a private meals-onwheels service for older people living in the region. As a shortterm effect, services would diversify and accessibility to services would improve.

Interventions and main points: • Improving the integration of home help services with sociosanitary coordination. • Getting services closer: accessible transport, accompaniment, lending adapted equipment, mobile library, home delivery meals, podiatry, supporting carers. This programme is evaluated each year, and its strengths include: • Fundamental characteristics of the intervention: multidimensional, coordinated and flexible, adapted to the needs of rural areas • Progressive introduction and well integrated by the councils. • Creation of jobs and local wealth. • Positively evaluated by the elderly people, carers and the professionals from the community network Improvement opportunities: • Boost programmes provided by socio-sanitary coordination. • Spread and diversification of home care services. • Move forward in the self-management of elderly people in social programmes. • Keep on trying to improve strategies that assist in the development of the network: institutional coordination, associations and community resources.

T H EM E 3 . |

COOPERAT ION BET W EEN PUBLI C, PR I VATE AND THI R D SECTOR | HÄME, FI NLAND

Long-term effects Helping older people to remain at home as long as possible will have positive long-term effects and savings. Enhancement of the quality of life is important for all elderly people. This best practice is extensible to age groups other than the elderly, such as families with children. From a regional development point of view, this would help the local development of services. One new service can generate other services in rural areas. Cost effectiveness This best practice is dedicated to those older people who can’t access day centres or find it difficult to get out of their own home. All preventive actions will be cost effective in the long run. The ideal system would be for all services to be delivered to older people in the same car, for example. It would save money, time and the environment. The challenge is legislation and local restrictions. For example, the same vehicle cannot deliver goods and people or food. And nurses can’t do the dishes. Local activity would strengthen the sense of community and a safe environment.

Finland. The close link to this breaking down distances might be a competitive advantage for some private well-being sector entrepreneurs. The interesting question would be how to combine different services into one entity, and how to bring that service to an older person’s home environment and make it a business. Volunteering can’t respond to all future service needs and the challenge of an ageing population generates new business opportunities. This example of best practice is good, but it is more suitable in Asturias than in Finland. We do have similar services here in Finland but the issue of services that are additional to original home care service is interesting. It might raise business opportunities within this region. There is a possibility for new innovative initiatives if several entrepreneurs were to manage the services together as a consortium. The integration of services would save time, money, resources and the environment. Bringing services to rural areas would also encourage other service providers to start a business in these areas. Services of different associations should also be available for people living in rural areas. Enterprises and associations should work together.

Possibilities for innovative initiatives There is a possibility to gain advantages in private sector organisations to invent mobile services like Mallu in other parts of

BEST PRACTICES 3. Collected by Brescia Heat-Health Watch Warning This initiative was born with the intention to respond to the summer heatwaves that caused many health problems among elderly people in Brescia. The project’s complexity was solved with an integrated strategy carried out by the public, private and third sectors, which was basically structured into three levels of action: 1. A project for the monitoring and support to frail older people in their own homes, to be activated in the summer but also during other emergency situations (technological or environmental); 2. The participation of a national programme - prepared by the Department of Civil Protection in cooperation with the Department of Epidemiology, ASL RM / E - of forecasting and warning (“Heat-Health Watch Warning”) of heatwaves that are particularly harmful to health; 3. The amelioration of heating and air conditioning of municipality hosting structures and the free supply of air conditioners to elderly people living in environmentally-sensitive situations. Such operations have been carried out with the cooperation of the municipality, a large number of associations operating in Brescia, private actors and specialists, the local university and the unions: only such a partnership was capable of achieving direct contact with all the 3,900 older people living in the area. Success was possible only through this cooperation between actors who were involved from the beginning of the project. The monitoring of elderly people’s conditions has been carried out by integrating monitoring carried out by specialists and preventing actions and visits carried out by neighbours: a good solidarity network of neighbours, which resulted in being effective from

a socio-emotive point of view as well as from a cost-effectiveness perspective. EVALUATION Transferability Heat-Health Watch Warning is established for emergency situations in the Brescia region. It is a cooperation model between public, private and third sector actors. The initiative was born with the intention to respond to the summer heat waves that caused many health problems among elderly people in the region of Brescia. The practice is interesting from Häme’s point of view. At first you might think that this kind of practice is not transferable to Finland. Some parts are easy to transfer to Finland. In the 2000s, Finland experienced a couple of very warm summers and it caused many health problems for the elderly population. The lack of fans/ventilators was significant across the population groups, but especially among older people. With this kind of cooperation model and network, some elderly people would have stayed at home instead of coming to emergency units because of exhaustion or fear. In Finland there are other possible emergency situations caused by winter and cold temperatures, for example, to which the idea of this best practice can be transferred. Volunteerwork is coordinated by Pysäkki here in Häme region. From Pysäkki you can ask for help and support for a variety of life situations. They also provide a call service called “Morning Ear” for elderly people. They make a call to older people every morning and if he/she doesn’t answer on the third call, someone will go and check the situation. Organising volunteer work on a large scale would be possible in Finland. Pysäkki has a register of 500 volunteers that are able to help quickly in

T H EM E 3 . |

COOPERAT ION BET W EEN PUBLI C, PR I VATE AND THI R D SECTOR | HÄME, FI NLAND

emergency situations. By law, all municipalities have contingency planning for emergency situations. When Finland had powerful autumn storms in 2010, only a couple of volunteers started to visit elderly people living in rural parts of Häme. Those few visited many people and checked that everything was all right. But the demand was greater than the supply. Emergency situations such as heatwaves are quite rare in Finland, but it would be important for some elderly people to know where to get ventilators/fans from as quickly as possible. Simply having the knowledge that they are not alone and that help is available might be important preventive activity. Temporary changes to the environment should be noticed in the everyday life of the elderly. Changes can be very small but they play a huge role in an older person’s life. In Finland this can mean that in the winter when the ground is slippery, an older person might not be able to go shopping for food. He or she would need help in this case and this proves that good network is essential. Short-term effects The need for treatment doesn’t increase because of this network. Volunteer work is an important element of dealing with the challenges faced by older people. Every older person could have their own volunteer mentor who would be responsible for a particular older person. The volunteers could help the older person to learn how to work with new technology, for example. Working with an active network of volunteers and one’s own volunteer mentor brings about a sense of security to the life of an older person. The mentoring system also enables us to tackle any problems at an early stage, as the mentors would be involved in the person’s everyday life. Long-term effects Helping elderly people remain at home as long as possible will have positive long term effects and bring about cost savings. Enhancement of the quality of life is important for all elderly people. With the help of volunteers, an elderly person might avoid hospital treatment, which brings about huge savings. The idea of the volunteer’s role as a mentor would also be

transferable to work involving the prevention of social exclusion of young people. Cooperation between different networks and volunteers will bring savings and positive effects in care processes in the long run and help the prevention of challenges related to the ageing population in the region. Cost effectiveness This best practice is based on networks and cooperation. When a cooperation model works effectively, it is a really cost-effective working method. For municipalities, volunteer work is very cost effective. Purchasing fans is not the responsibility of the municipality. Older people can buy them themselves and then a volunteer can install them. This is preventive action and is very cost effective in the long run. During autumn storms, this kind of volunteering system can also be seen as preventive action. Elderly people don’t have to be afraid in their own homes. Somebody will check on their situation once in a while. With this cooperation network we are able to prevent unnecessary visits to the doctor or to the hospital. Possibilities for innovative initiatives For private entrepreneurs, providing services in emergency situations is a business opportunity. These services can be marked as additional products/services – just being there in case something happens. There is a possibility that some private entrepreneurs might find a competitive advantage from this good practice and transfer some parts of it to their business. In the future, elderly people might be ready to pay for some extra services that might be provided by volunteer work at the moment. Extra services could include someone being on call if an older person needs help. The elderly might not want to pay for this but relatives that live far away might be ready to pay for this kind of extra service. This could possibly be part of the private home care provision for some private entrepreneurs. Private entrepreneurs could extend their services to include this. Associations could also charge for their services. Volunteering strengthens the activities of associations.

4 Theme 4.

Enterprise approach Lorraine, France

T HEM E 4 . | ENT ER PR I SE APPROACH | LORR AI NE, FR ANCE

Description of the theme

he ageing population is a wide subject covering an important range of issues, subjects and questions. As far as companies are concerned, we can identify the main issues as follows: • Business transfer: what are the models that need to be developed in order to inform, aware and support companies? (ageing population, a reduced economically active population, impact on the transfer of businesses). • Senior market: a very fragmented market.

Need for new markets and services in numerous sectors and industries such as health, personal services, leisure, food, construction, home automation, gerontechnology, insurance and mutual societies, textiles and clothing, and ICT. • Role of older people in companies: cultural and social approach, inter-generational links • Vocational and lifelong training: there is a strong need for the training of people working in services for individuals (growing sector facing a shortage of qualified staff).

BEST PRACTICES 1. Collected by Asturias Innovation activities in day centres into the area of home care services The topic of this best practice is the prevention of isolation and preventive therapies for dependent people. Some day centres for dependent elderly people in the Asturias region have developed innovative activities for their users, in order to develop their mobility and cognitive aspects by using new technologies. The principal objective is to carry out activities using new technologies in order to develop the mobility and the cognitive aspects of dependent elderly people. The elderly people involved in these day centres have some pathologies which create problems in terms of mobility and cognitive deterioration.

Short-term effects • Studying the conditions for transferring this practice can sustain current research and work conducted by the French public and private sectors.

The innovative activities: • Use new technologies such as Nintendo Wii to promote mobility and cognitive stimulation. • Use computers and specific programs in order to develop cognitive stimulation, working on exercises like maths, colours, forms, etc.

Possibilities for innovative initiatives Sector is favourable to technology innovation in general.

The indicators used to evaluate the success of these activities are the people involved and their own outcomes. Every year, the number of people involved in these activities is increasing, Some jobs opportunities, such as therapists and physical therapists, have been created. EVALUATION Transferability • Positive Conditions in Lorraine to transfer the Best Practice : - Corresponds to a growing interest in the use of ICT in the prevention of cognitive problems - Numerous laboratories in Lorraine working on this field of research • Current barriers to or difficulties with the transfer - Need for a stronger structuring of initiatives and transfer to industry - Problem of solvency to develop the market

Long-term effects • Job creation, provided new business models and social pensions can be found (current problem of solvency). • Need for complementary information on the typology of jobs. • Improvement of living conditions for elderly people. • Medical and social progress

T HEM E 4 . | ENT ER PR I SE APPROACH | LORR AI NE, FR ANCE

BEST PRACTICES 2. Collected by Häme Keinusaari Senior Campus Keinusaari Senior Campus offers different levels of housing, support and welfare services for elderly people. Centralised services are located in Hämeenlinna city centre, close to all amenities. The aim of Keinusaari senior campus is to provide elderly people with specific housing in the Hämeenlinna area and to offer a concentrated assisted living facility and dementia care for Hämeenlinna residents. Keinusaari senior campus aims to combine other services supporting elderly people for the older people’s residence. Keinusaari area’s planning began in 2006. The first rental apartment stock of 51 apartments for elderly people was finished in 2007. In 2008, the Yrjö- and Hanna säätiö built a concentrated assisted living facility and dementia care unit for 60 customers. In this unit, a private well-being provider offers its services. In addition to this, many new privately-owned apartments can be found in the Keinusaari area. Their inhabitants enjoy a communal social area with shared outdoor fitness equipment. There is an information desk and a restaurant on the Keinusaari senior campus. There are also a number of multi-purpose rooms, saunas and a gym. A private hair salon and pedicure business also operates there. The city of Hämeenlinna’s daytime activity for elderly people is organised at the Keinusaari senior campus. In addition, the third sector organises free time and stimulation activity onsite. The strengths of Keinusaari senior campus are as follows: different housing options in the same area, a service centre with a restaurant in the same building, accessible housing and environment, and all day-to-day services can be found nearby,

including a grocery, health centre and cultural centre. Keinusaari senior centre is located in the centre of Hämeenlinna. EVALUATION Transferability • Positive Conditions in Lorraine for transferring the best practice : - This practice corresponds to a growing demand from individuals and the French public authorities to encourage independent living and housing specifically designed to meet the needs of senior citizens. - The French national health and pensions organisation finances initiatives to support home care telemedicine. Local authorities (Conseils généraux) finance private and public services to individuals. • Current barriers to or difficulties with the transfer - To a complete transfer of the best practice, new business models have to be created. The French national health and pensions organisation does not finance construction and housing specifically designed for people suffering from Alzheimer’s disease - Problem of solvency: money has to be made available for the market of services to individuals to grow. - Cultural consideration: difficulty in the cohabitation between autonomous individuals and dependent people. Short-term effects • Contributes to the response to the increasing demand among the elderly to live independently and develop social relations. • Studying the conditions for transferring this practice can sustain current research and work conducted by the French authorities to favour independent living rather than institutionalisation. Long-term effects • Impact studies are not numerous enough to measure impact in the long-term. Moreover, the French Ministry for elderly people has just launched a joint ministerial study (Mission Broussy) to define tools and measures for independent living and housing specifically designed to meet the needs of senior citizens. This report, and potential proposals for new business models, is to be published in January 2013. Political and financial developments that should recommend this report will make the measurement of this best practice transferability easier. Cost effectiveness Complementary information and data have to be considered to measure the cost effectiveness: • Building occupancy rate • Impact of cohabitation of both autonomous and dependent people • Cost comparison between this BP model and the institutionalisation of dependent people (dementia) Possibilities for innovative initiatives Innovative services, particularly from the private sector, can be stimulated: growing demand, new services and products linked to the silver economy.

T HEM E 4 . | ENT ER PR I SE APPROACH | LORR AI NE, FR ANCE

BEST PRACTICES 3. Collected by Umeå Innovation Gateway/Innovationssluss Västerbotten Support innovations that meet the future needs of new products and services for prevention, diagnosis, treatment and cure of disease. New business opportunities, economic growth, quality, efficiency and productivity in health care services. The aim of Innovation Gateway Västerbotten is to create a physical environment to utilise and develop the creativity found among employees in health and social care. This creates new businesses and growth in the community, as well as quality, efficiency and productivity in health care and social welfare services. Innovation Gateway Västerbotten is a support centre for employees in health care and social welfare services in Västerbotten county, Umeå municipality and Skellefteå municipality. The support always begins with an idea from one or a group of employees who contact the project manager of Innovation Gateway Västerbotten. The project manager offers support in the different steps towards a commercialised product/service involving business intelligence, market analysis and field testing of the product/service. Innovation Gateway Västerbotten can also contribute financially to enable development work maintaining a full salary, and support through what is termed “Innovation Cheque”. The product/service that will be developed is evaluated by an evaluation agency with experts from Umeå University and the University Hospital of Umeå. An idea or innovation often results in commercialisation, where the innovator sells the idea/innovation to a company or starts a company to launch the product/ service. Innovation Gateway Västerbotten also serves as a contact for SMEs that want to test a product/service within the health care or social welfare services. Participating stakeholders are Västerbotten County Council, Umeå municiaplity and Skellefteå municipality. Regional innovation system/cooperation partners are Almi Företagspartner AB (northern region), Entreprenör Centrum Västerbotten, Innovationsbron, Innovation Västerbotten, Uminova Innovation, Västerbottens Chamber of Commerce and Företagarna Västerbotten. The best practice is funded by VINNOVA (the Swedish governmental agency for Innovation Systems), Region Västerbotten, Västerbotten County Council, Umeå municipality and Skellefteå municipality. In 2011 four innovators had been granted support by Innovation Cheques in the recent period. Support has been given to both existing companies and innovators within the health care sector that are planning to start companies in order to develop the product/service further. One innovator is close to a licence agreement with the Swedish enterprise Swereco to commercialise the innovation. The Umeå-based company Kontrollera Scandinavia AB has tested an ICT solution to prevent errors and deviations within two elderly care units in Umeå municipality. The ICT system will be evaluated at the end of the test period but good results are already being seen. EVALUATION Transferability • Positive conditions in Lorraine to transfer the best practice : - Strong organisation of partnerships and tools to support companies’ creation projects: from the project idea to its implementation. This approach includes the creation of new and innovative activities. - Recent designation of a local public organisation as “Relay Centre” by the “CNR santé à domicile et autonomie” (Na-

tional centre for home health and autonomy). Its objectives are to identify project actors and good practice within a specific area. It could support the transfer of the methodology approach developed by the Innovation Gateway Västerbotten at the regional scale. • Current barriers to or difficulties with the transfer - Need for increasing awareness among health actors of the creation of new activities (entrepreneurship culture to be enhanced). - Need for stronger links between the agency in charge of detecting projects and health sector companies. Short-term effects • Creation of new activities, added value and jobs. • Reinforcement of partnerships in the implementation of the platform, above all partnerships with health actors. • Implementation of a new tool known as “Innovation Cheques”, dedicated to feasibility studies. Long-term effects • Creation of new activities, added value and jobs • Reinforcement of partnerships in the implementation of the agency, above all partnerships with health actors There is a need for further information on the way projects are detected to better anticipate long-term effects. Cost effectiveness The following data and information are to be considered for an initial evaluation of the cost effectiveness: • Evaluation of projects already carried out through the agency and its tools. • Cost and return on investment of the Innovation Cheques. • Complementary information on the methodology used for the detection of projects Possibilities for innovative initiatives Favourable approach to innovation: partnerships on different levels, allowing study phases, (for instance feasibility study), tests directly conducted with final users or at least professionals working on a daily basis with these end users.

5 Theme 5.

Housing, solidarity, fight against isolation, information and proximity, mobility and accessibility Metz, France

THEME 5. | HOUSING, SOLIDARITY, FIGHT AGAINST ISOLATION, INFORMATION AND PROXIMITY, MOBILITY AND ACCESSIBILITY | METZ, FRANCE

Description of the theme

he CCAS of Metz is responsible for the social policy of the city relating to older people with voluntary and institutional local partners, to try to provide solutions to issues of ageing by: • Promoting the position of older people in the city • Informing and giving advice and guidance to older people and their relatives • Fighting against isolation • Proposing housing suited to requirements and circumstances • Strengthening solidarity between the generations The city of Metz was awarded the French label “Bien vieillir-vivre ensemble” (“Getting older healthily – living together”) in 2010. An “urban audit” has been set up with the municipality, the CCAS and their public and private partners, to clarify the situation and identify the needs of the older people in the city. This approach led to the drafting of a charter

of ten commitments in 2010, concerning housing, social life and solidarity, and autonomy and mobility. For the CCAS of Metz, the EFFECT project was seen as an opportunity to share experiences and knowledge with other European regions, and to see what services are delivered by the public or private sectors in these countries, regarding these topics. With the ageing population and the strengthening desire among older people to remain in their own homes, it is necessary to be able to answer to the demands of these individuals and their relatives, to get local information, to have or to be able to access suitable accommodation, and to move about safely in the city. Most older people live at home, just as they want to, but in general they are isolated, because they do not have any family or friends or they don’t live nearby. In summary, the Metz theme concerns how to enable elderly people to live in good conditions at home and in the city as long as possible.

BEST PRACTICES 1. Collected by Umeå Welcome in - social meeting spot and cafe for adults and senior citizens in Umeå The topics of this best practice are • Preventing isolation • Stimulating activity and social interaction • Disseminating information • Meeting spots for adults and senior citizens and social organisations The objective of the approach is to promote health and quality of life by offering a meeting spot and activities for adults and senior citizens in Umeå. The “Welcome in” establishment cooperates with local educational associations that take part in the various activities arranged. Visitors are also invited to co-arrange activities and try out their ideas. The cafe is open from Monday to Friday 10:00 to 15:00 and Tuesdays 18:00 to 20:00. The cafe is run by the unit responsible for daily activities for people with disabilities, while the activities are planned and managed by the unit responsible for preventive actions. Activities are arranged during usual opening hours as well as at other times and on other days, depending on the activity. The activities are based on strategies/activities that are proven by scientific research to

have good results on health and quality of life: social interaction/ participation, meaningfulness/quality of life, physical activity and healthy eating habits. “Welcome in” also offers municipal information in the form of question and answer sessions and brochures. “Welcome in” is the second meeting spot in central Umeå that targets the elderly. In 2010 the first meeting spot, “Aktrisen”, opened in the western parts of central Umeå. A participating stakeholder is Umeå municipality (the unit for preventive actions, the unit for application and needs-based assessment and the unit for daily activities for people with disabilities). National stimulus funds (“Stimulansmedel”) financed the planning of the social activities (from 2009) and the start of the “Aktrisen” and “Welcome in” meeting spots until the end of 2011. “Welcome in” will be financed via municipal annual budget from January 2012. The social content of the meeting spots has been developed over the past two years and is now available as a guide to social interaction and activities targeted at older people living in their own home. Preliminary results suggest that the objectives of “Welcome in” – to prevent isolation and stimulate activity and social interaction – are achieved.

THEME 5. | HOUSING, SOLIDARITY, FIGHT AGAINST ISOLATION, INFORMATION AND PROXIMITY, MOBILITY AND ACCESSIBILITY | METZ, FRANCE

EVALUATION Transferability: “Welcome in” is a really innovative practice because it offers a meeting location not only for older people but also for younger adults. It’s really important to have places which allow for the economically active population and retired people to meet and give them the opportunity to enjoy activities together. This kind of place enables older people to feel that they are included in society. “Welcome in” is a place which spreads information and it is important to have a place which allows information to be provided to older people and their relatives. What is really interesting about “Welcome in” is that activities are organised with the cooperation of educational associations and they are co-arranged by the visitors. This way of building activities is very good in order to maintain independence and to stimulate social interaction. “Welcome in” could not be transferred to private entrepreneurs, but it could be effectively provided by a local authority or an organisation financed by a local authority. This best practice approach could easily be transferred to another location because it is not difficult to set up. It simply needs premises and staff. There are no environmental conditions in the region which could affect the transfer of the approach. The legislation allows for this kind of innovation and this kind of service doesn’t need authorisation.

It is not an entrepreneurial opportunity – it should be restricted to organisations which can procure the relevant activities. There have always been locations where older people can meet, find information and enjoy activities. These places are often managed by associations. The difference is that they are designed specifically for older people. For social interaction it is better to have meeting locations like “Welcome in” which provide opportunities to younger and older people to meet together and treat older people just like other citizens. Short-term effects As a short-term effect, we could note that this is an opportunity for other adults to change their perspective on the older people in their community by allowing them to meet and enjoy activities together. This kind of meeting location could affect the functioning of similar places that are designed exclusively for older people. Therefore, it would probably be necessary to encourage cooperation between the existing provision and that similar to “Welcome in”, in order to maintain a choice between the two services. If a local authority like a social service organisation decided to set up a “Welcome in”, it would require a budget to manage it directly, or it would need to finance an association to provide the service. In this second situation it could be an opportunity for the commissioned association to develop its activities. Long-term effects “Welcome in” is an opportunity to provide a social response to the prevention of isolation of older people by including them in activities with younger generations. It is a way to help social interaction to develop and to change the general perspective on retired people. This response is in the national strategy to include older people in the life of cities, to allow them to have an active life adapted to their capacities. This strategy is defined by the national label “Getting older healthily – living together”. In adapting this best practice, risks can be identified: some older people, especially the oldest, prefer to have meeting locations reserved exclusively for retired people. Cost effectiveness The selected best practice would not reduce costs in our organisation because it would not lead to a reduction in the existing meeting locations and would call for new means: operating costs, premises, employees. As a competitive advantage, we can see all the savings brought about by preventive actions which cannot be effectively evaluated: preventing isolation, enabling social interaction, providing advice and guidance, maintain independence, etc. It is not necessary to make investments to implement approaches that need premises that could be found in existing buildings, because it is important that these meeting locations are in the city, and wherever possible, in the city centre. A local authority like a social city centre could find the resources to adapt the best practice approach and manage it or finance an association which could set up and deliver the project. Possibilities for innovative initiatives In the long term, the competitive advantage of this approach will be for the entire population and the public authority which finances care for older people (home services and retirement housing), not for the local authority which manages the meeting location or finances the association which manages it. It will not lead to new business ideas that private entrepreneurs could benefit from because this is a social matter.

THEME 5. | HOUSING, SOLIDARITY, FIGHT AGAINST ISOLATION, INFORMATION AND PROXIMITY, MOBILITY AND ACCESSIBILITY | METZ, FRANCE

BEST PRACTICES 2. Collected by Häme Well-planned quality housing research In the Forssa region, the ageing population is a challenge. Older people’s home institutions are not able to answer future service needs and increasing demand. The aim is to support ageing people to live at home as long as possible. On the other hand, in the centre of Forssa, there are empty apartment buildings. These apartments don’t meet current requirements/needs. The aim is to offer well-planned quality housing for elderly people, to support them to live at home for as long as possible and to utilise empty or little-used apartments in the centre of Forssa. The development centre of the Forssa region (FSKK= Forssa Region Development Centre Ltd) is responsible for the development of the well-being cluster in that particular area. The primary task of the healthcare federation of the municipality of Forssa (FSTKY) is to promote people’s healthcare services in that area. FSTKY’s task is also to promote medical treatment, research and rehabilitation by producing services by itself or purchasing them from private institutions/companies. Wellplanned quality housing as a whole aims to support independent living for longer. This process consists of different entities, such as well-being TV, well-being federation of municipality process description and this, already mentioned well-planned quality housing research. This well-planned quality housing research is carried out by Tampere Technical University, as thesis work. The thesis questions were as follows: How can we support older people to stay at home for longer with only small changes to the home environment? What kind of life cycle housing could be an effective response to the changing needs of inhabitants? In housing we must also pay attention to internal and external absence on grounds for disqualification, the need for common space and

the use of common space to support social intercourse and a sense of community. Home care services and existing service supply could be included in this housing arrangement. Well-planned quality housing might be an answer to Forssa’s challenge to take care of its ageing population and future service needs. The use of empty apartments has budgetary benefits for the city of Forssa, and this arrangement has possible success factors, whilst difficulties are encountered. This will strengthen cooperation between the well-being sector and other city organisations. EVALUATION Transferability Well-planned quality housing research could bring many benefits to our region and our city by giving older people the opportunity to remain at home longer and to live independently in the city, close to shops and services. This best practice approach would be more appropriately transferred to social housing companies because they are in charge of managing housing. For our region and our city, the outcomes of the approach are not so transferrable because the housing situation in Metz, particularly in the city centre, is not the same that in the Forssa region of Finland. There are no empty social housing flats and there are few in private housing sector. With empty flats in the social housing sector and with the financial means, it would be relatively easy to adapt them to the needs of older people. In the private housing sector it would be

THEME 5. | HOUSING, SOLIDARITY, FIGHT AGAINST ISOLATION, INFORMATION AND PROXIMITY, MOBILITY AND ACCESSIBILITY | METZ, FRANCE

more difficult because it is unclear whether all older people have enough resources to finance the adaptation of their accommodation. There is an opportunity to reflect our city’s experience and expertise in the selected best practice approach because we have developed a framework to evaluate the affordability of accommodation in collective housing. Short-term effects As short-term effects the selected best practice could be a solution to the increasing demand among older people to live in the city, close to shops and services. Private entrepreneurs could benefit from the best practice because adapting the accommodation for the use of older people would require work. Enabling older people to live at home would reduce the demands on retirement accommodation by people who are losing their independence but are still able to stay at home in an adapted flat. If the best practice approach could be transferred because of empty apartments, the social housing companies would need financial resources to finance the works for adapting the flats. Long-term effects This approach could be in line with the city’s long-term strategy of including older people in city life. As long-term side-effects, we think that the approach might bring opportunities for developing home care services. This best practice could be adapted without risk in our region because it would answer a real need among older people. It would bring some differentiation advan-

tage to the city by making it attractive for older people. As we consider that the approach would provide a development opportunity for the home care services, it would be necessary for the region to set up training for people who want to work in this sector (private or third sector). Cost effectiveness The selected best practice approach could reduce the costs of home care services and reduce prices for customers. There is no need for investment in order for this best practice approach to be implemented. The local private entrepreneurs and third sector organisations in the home care service industry could have the resources and capabilities to answer to the increasing demands of older people. With regard to the financial needs for social housing companies to finance the works to adapt the flats, it would be necessary to identify resources that wouldn’t push the rents for the adapted accommodation up too much and make them too expensive for older people. Possibilities for innovative initiatives The approach could provide real competitive advantages by giving work to the companies which would have to adapt the accommodation. Increasing the home care services sector would also provide more local employment opportunities. The best practice approach would also provide possibilities for the development of innovative products, equipment or services related to adapting housing. The implementation of the approach wouldn’t imply a new area of competence for any local authority because it would be carried out by social housing companies.

THEME 5. | HOUSING, SOLIDARITY, FIGHT AGAINST ISOLATION, INFORMATION AND PROXIMITY, MOBILITY AND ACCESSIBILITY | METZ, FRANCE

BEST PRACTICES 3. Collected by Brescia BIRD - Small protected houses This is a pilot initiative (BIRD = green building, inclusion, energy, home automation) co-funded by the Lombardy Region. The service addresses older people or people at risk of social exclusion, who are unable to live independently without social and/ or health protection, and who require a secure environment. The intervention consists of 57 apartments distributed across various parts of the city. Mini apartments are divided into different forms of protection. Low protection housing: support is provided, 24 hours a day, via a helpline, ensuring immediate help when a call is placed through Withe Crow service. People can be supported by the home care service in relation to their need. Medium protection housing: support is provided by a hosting centre close to where the people live. Individuals can benefit from different services such as home care, health assistance, cleaning, transports, and so on. Depending on the level of protection, benefits are identified together with the levels of contribution to the cost of the services. The role of families is designed to support older people living in the area, both in day-to-day activities and as well as in case of critical events (e.g. sudden illness ....) This practice allows elderly people to stay in an independent environment and to take care of themselves. In case of particular conditions, the intervention level can be increased without changing their environment. The adopted solution guarantees the possibility to build up a local network involving families and to avoid social exclusion, thus providing a clear role to everybody. As regards the local authority, this solution is low cost, compared to the recovering into ad hoc structures. EVALUATION Transferability It is interesting to have a global solution for housing including a number of apartments distributed across various parts of the city, divided into different levels of protection (low and medium). This best practice could be transferred, but with some adaptations. With regard to the low-level protected accommodation: this system exists in France, but not in this organisation. Older people can access a helpline, ensuring immediate help at home, but they buy this service from organisations which have a call centre that the elderly can access in case of emergency. The operator of the call centre will contact ,the relatives of the old person or the hospital emergency services to instigate intervention when necessary. A helpline system that is run by volunteers does not exist in France because this service can only be furnished by professionals. With regard to the medium-level protected accommodation provided by a hosting centre close to the apartments where the elderly live, this kind of housing already exists in France. In our system the services are provided inside a retirement home. What is interesting in the Brescia solution is that the services (catering, recreational activities, bar, etc.) are open to the elderly in the neighbourhood. There is also a gym that is used by local sport associations. This open way of functioning enables the elderly to meet with people of many generations: they can thus feel included in society. In our retirement homes we have recreational activities which could be opened up to elderly people living independently, and some of our services could be rented

out to other organisations. In the medium-level protected accommodation, there are 48 apartments rented to independent older people and four rented to families. Each family is responsible for 12 old people and they intervene in case of need and emergency. What is interesting is that when a family is absent, there is always another family who can answer the old person’s needs. In each family only the woman is employed. She is not paid a salary but the apartment is provided free of charge. This method could not be transferred in France because the provision of accommodation in lieu of a salary is prohibited. Short term effects Transfer of this best practice in an adapted way could be an opportunity for opening up more of our retirement homes and particularly locating them within the neighbourhood. It could also be a way to diversify our services and bring more life into our homes, which could make them more attractive. Long term effects This best practice could be in line with long term strategies of the municipality, which is guided by the objective “Getting older healthily – living together”. Making our retirement homes lively places where older people live but can also meet with other people would be very good for them to maintain their physical and intellectual selfsufficiency. It could also contribute to helping other people to change their views of older people and consider them as citizens just like any other group – perhaps as people who have retired from work, but not from life. Cost effectiveness This best practice approach could decrease investments and operational costs by responding to many needs in one place (a retirement home): housing for older people alongside space for external groups and organisations. Possibilities for innovative initiatives This best practice approach could bring about benefits by providing evidence that it is possible to answer several needs in the same place. It is a way of inventing solutions to make retirement homes for self-sufficient people not just places for accommodation but also places to live alongside other people.

6 Theme 6.

Service procurement, purchase process Ume책, Sweden

T HEM E 6 . | S ER VICE P ROCUR EMENT, PURCHASE PROCESS | UMEÅ, SWEDEN

Description of the theme

ocial services, such as elderly care, can be provided by public or private actors in Sweden. Two different pieces of legislation regulate the provision of social services by private actors in Sweden, the Public Procurement Act (2007:1091) and the Act on System of Choice in the Public Sector (2008:962). The Act on System of Choice is adopted at the municipal level and regulates the procurement of private actors that can act within the municipality in a much wider sense than the Public Procurement Act. The purpose of the Act on System of Choice is to open up the system to a range of different actors and to let the care receiver decide which care provider should provide the service. In Umeå municipality the Act on System of Choice has been adopted in home care services. This means that each private company that fulfils the specified requirements in the Special Conditions of Contract are able to provide home care services to those people that have a needs-based assessment stating the need for home care services. The home care providers are financed by a fixed amount payment for each hour of work and each care receiver they service. The municipality is responsible for providing information, setting quality standards as well as managing regular follow-ups on all home care providers within the municipality. The Umeå municipality theme within the EFFECT project has been a qualitative procure-

ment process regarding the home care services provided within the Act on System of Choice. The main focus has been to develop a systematic work stream for the procurement procedures and to secure the quality of the services provided by private and public actors regulated by the Social Services Act and the Act on System of Choice. This approach requires new working methods and new knowledge, which the municipality would like to gather from the EFFECT partners’ best practices. A mapping of the process has been carried out, and a common “ideal process” has been adopted by personnel within the procurement and purchase office and the social welfare services office. The four identified areas of improvement are the most urgent topics to deal with in order for the procurement process regarding home care services to be of the high quality the municipality aims for. Identified areas of improvement: • Co-operation between the procurement and purchase office and the social welfare services office • Method for in-service training for employees working with procurement as well as within the social welfare services • Systematic method for follow-up on contracts with private actors • Systematic work with a specification of requirements and fulfilment of demands for both private and public service suppliers

BEST PRACTICES 1. Collected by Asturias Best practice guides care homes for elderly The objective of the practice is to develop a quality model for person-centred assistance, which focuses on: • Moving from a system centred on the person’s limitations to one centred on capacity and self-determination. • Moving from a system centred on efficiency of services, programmes and activities to one centred on improving quality of life. • Moving from a system centred on professionals to one centred on the person and their relatives. Best Practice Guides were developed to help and guide

professionals and managers and to improve the quality of life of users through professional actions. The guides have been created using participatory methodology, analysis and reflection in the different assistance environments. Some interdisciplinary knowledge was systematised and created from practical experience through a number of training seminars. The guides were made by 380 professionals working in care centres for dependent people in the Principality of Asturias. They used external advice. There are 28 examples of best practices for the users’ quality of life.

T HEM E 6 . | S ER VICE P ROCUR EMENT, PURCHASE PROCESS | UMEÅ, SWEDEN

Transferability As Umeå Municipality is already active in development work, the Oviedo approach could easily be transferred as a method for change of experience and competence within the organisation. As well as spreading good examples, we need a way of tackling areas for improvement and linking best practice approaches from one working group to another. This could be done quite naturally. Evidence-based practice is the key word for the social welfare services, and by using the best practice method this could be achieved, as those approaches spread to other working groups should be properly tested and evaluated.

Content of Best Practices Guides: Part I: Bases and reflections on the best practices in centres for dependent people. Part II: Identification of the best practices and methodological suggestions for their implementation. This practice is considered a good practice because: • It has a high level of involvement from technical teams in different centres who work with older people • It is trying to change the way of thinking of professionals concerning the centres, their work and the users in order for there to be a more natural relationship between them. • It is trying to change the language, searching for terminology which dignifies the people and their work more. • It shows concern and respect. EVALUATION Umeå Municipality’s social welfare services began a massive development programme in 2009 to improve the focus on the end user, to make better use of the potential within the organisation and to meet the economic challenge. This work has been done mainly by mapping and reshaping the organisation from within, using the people working closest to the end users to make suggestions for alternative methods that align with the main goals. During these past few years, many new ideas and methods have been adopted in different working groups and the next step is to learn from each other in order to be able to adopt the identified methods in different areas. One way to do this work would be to use the Oviedo best practice method “Best practice guide care homes for the elderly”. Working with best practice approaches highlights the positives within the organisation and within the personnel working with social welfare services. The emphasis of the best practice guide is to learn from each other instead of learning by doing, and by creating a working culture which promotes a sharing of experiences. Another strong point is the rigid end user focus, which allows the older people and their abilities be the main focal points for the welfare services, instead of the personnel’s abilities and wishes.

Short-term effects The immediate end user focus is probably the most striking outcome of this best practice and this should be evident quite quickly in the face-to-face interactions between older people and their care providers. In the short term there is a risk of development work fatigue within the organisation. Many working groups are developing well in terms of with what they have identified and they would may be happy to continue to focus on those specific things for a while. However, there are still many improvements to be made throughout the organisation and with a common method to tackle these improvements, it could be the right time to do so. The ongoing development work gives the organisation good potential for finding the right competence to work according to the Oviedo method within the organisation. Long-term effects The main ideas of the best practice guide are in line with Umeå Municipality social welfare services’ long-term goal: to strengthen the end users’ independence and autonomy, which would give the adoption of the best practice sustainability, even in the long run. Parts of the best practice guide go against the national aim to strengthen routines and standardisation within the social welfare services area. In order to progress against the national notions we would probably need to alter the method a little bit to better suit the legislation and guidelines in the field of social welfare services in Sweden. Cost effectiveness If linked to the active development work there would be no specific investments or costs needed to transfer this best practice approach. It would simply be a shift in working methods and we are already focused on doing this kind of work during the coming years. To be able to draw best practice from within the organisation instead of going outside the municipality could be a cost-effective way of further developing the organisation. Possibility for innovative initiatives The Oviedo best practice guide offers quality issues in an innovative way that may lead to new ideas and working methods. End notes As mentioned in the best practice guide, the involvement of managers/heads of unit is crucial. On the other hand the people that are involved must also work closely with the end users and must be able to describe the need for improvement/the problem as well as the fundamental issues related to their best practice approach. The organisation of the development work in Umeå must take this into account as well as the need for the management and overview of the processes within the organisation.

T HEM E 6 . | S ER VICE P ROCUREMENT, PURCHASE PROCESS | UMEÅ, SWEDEN

BEST PRACTICES 2. Collected by Lorraine Pension Insurance Welfare Services, tailor-made action plan (CARSAT NORD EST) The topic of this best practice is home assistance, tailor-made support for senior citizens who need help with their day-to-day life, particularly through the financing of home-help services. Carsat Nord Est is establishing a policy for supporting and preventing the loss of independence, targeting pensioners from GIR 5 and GIR 6 on the Aggir national evaluation grid: the support it offers is therefore aimed at the least dependent pensioners, namely those who still live independently or only need occasional help for certain activities in their everyday life. Thus, the tailor-made plan aims to identify and pay for the services required for the well-being of pensioners and their ability to remain in their own homes, and is targeted at senior citizens aged 55 and above within the general pension system, who maintain their independence but still demonstrate a need for help because of their health, living conditions or isolation. In general, this plan lasts for two years. The implementation of this system assumes an assessment of the needs of pensioners at home which then enables a tailor-made action plan to be created, by identifying solutions which are adapted to each individual case. This comprehensive evaluation of the requirements is undertaken by staff trained by CARSAT but who work for external organisations that it has approved. The assessment of requirements is carried out using the Aggir grid, and is linked first and foremost to the level of autonomy that the pensioners have. Other criteria are also taken into account, in particular that of fragility: this criteria emanates from national studies validated by scientists and enables finance to be directed in the best way possible, given that CARSAT receives a large number of requests.

The system can finance various services, such as homehelp, meals provision, grocery deliveries, help with going out, transport and holidays, remote alarm devices, home grants enabling accommodation to be adapted, etc. The tailor-made action plan has an upper ceiling of 3,000 euros per year and per beneficiary. Co-financed by CARSAT, it also assumes a contribution from the beneficiary, which is variable according to their income level. Once his or her needs have been assessed, the beneficiary can freely approach the service provider of his or her choice without his decision being directed by CARSAT. The success of the system requires, first and foremost, a very refined analysis of the needs of senior citizens, using a very precise evaluation grid and sensitivity from professionals. In all instances, the transfer of this practice assumes an adaptation of state pension insurance schemes. This best practice has been successful because of: • The importance of targeting: action plans are tailor-made for an improved response to requests. This approach is made possible by strong and continuous evaluation of this system. In order to do this, CARSAT uses national impact indicators, indicated within management contracts lasting several years that it draws up with the National Old-Age Insurance Fund for Salaried Workers (CNAVTS - Caisse nationale de l’Assurance Vieillesse des Travailleurs Salariés). In 2011, around 20,000 tailor-made action plans were functional across the region covered by Lorraine CARSAT, and around 19,000 global assessments took place during the same year. These high numbers demonstrate that this system is responding to a clear requirement and has been successful.

T HEM E 6 . | S ER VICE P ROCUR EMENT, PURCHASE PROCESS | UMEÅ, SWEDEN

• Contribution to the well-being of senior citizens, enabling them to remain in their own homes thanks to help adapted to their requirements and provided in such a way that they can remain in their homes for as long as possible and in good living conditions (e.g. home-support provided by occupational therapists) • Opportunity for economic development through the creation of jobs within the home care sector and an influence on other markets by sustaining the consumption of senior citizens (remote alarm systems, excursions, leisure activities). EVALUATION In recent years, Umeå Municipality has made intensified efforts towards enabling older people to live independently in their own home for as long as possible. This effort is supported by flexible solutions to support older people in their home environment and the municipality is constantly searching for new methods and ideas to support this approach. In this work, intensive activity with preventive and individualised actions is crucial to ensuring that older population have a better quality of life in their later years. Transferability The support and care given to older people in their own homes is already provided following a needs-based assessment performed by a municipal social welfare officer. A financial compensation framework is also in place, granting the support recipient a minimum income following payment for needs-based support and care fees. For services provided to older people without a needs-based assessment, a national tax reduction system reduces the cost for home services, such as cleaning and washing clothes. The interest in tailor-made solutions has grown within the municipality in recent years, and the Lorraine best practice approach is an interesting way of providing individual solutions that could be transferred in parts relatively easily. The early efforts to enable independent living described in the best practice guide is a good way to support older people in their own home. In Sweden, the age of 75 is viewed as suitable for the promotion of preventive actions, making it appropriate as the starting age for the adoption of this kind of system. Short-term effects One immediate effect would be better possibilities for individual choices and the possibility to be even more in control of who provides the services and where and when they are provided to you.

Long-term effects The possibilities for individual choices and a tailor-made service provision are also long-term effects. The preventive approach of the best practice approach safeguards many different positive effects from a long-term perspective, including the possibility of remaining independent for longer. Cost effectiveness It is difficult to estimate the cost effectiveness of a system that supports individual solutions. A common way of thinking within the public sector is that larger volumes of products or services often lead to lower prices due to of public procurement. In order to grant both large quantities and the possibility to choose among different providers, a special set of rules must be in play to ensure adherence to the Act on Public Procurement. If this is not set into action it could result in increased costs, as smaller amounts of services are put through the procurement process. Possibility for innovative initiatives The Lorraine best practice approach could result in many new business opportunities for SMEs with competence in home services. In Sweden, and in Umeå in particular, this kind of service niche is already growing and many private actors are already active in providing home care services to people within the region thus making the market less urgent for new businesses and innovative initiatives. End notes The system provided in Umeå today is based on different approaches which are all tied to the Act on Public Procurement. Some services are already provided by different actors, for example home care services, but most services are provided by a single actor, which provides little option for individual choice among the older population to enable them to choose the provider of the needs-based service. On the other hand, there is a great variety of service providers for services not subsidised by the municipality via needs-based assessments. In order to come to terms with this, we would need a new way of adopting the Act on Public Procurement that enables older people to be the ones to decide on the service provider of their liking. Another challenge for Umeå Municipality is to involve the third sector in the system. A third challenge would be to come up with a system that does not lead to people with more money being able to get more help and better services than people with less money. The system should rather support the notion that those who need help will get the best services available at an affordable price.

BEST PRACTICES 3. Collected by Häme Well-being cluster in Hämeenlinna and Forssa region In order to produce well-being services efficiently, we need to develop companionship and co-operation in order to promote regional prosperity. The aim is to change attitudes in the private and public sectors so that it supports the development of wellbeing services and entrepreneurship in the area. The goal can be described as follows: to promote wellness of citizens but also environmental well-being, to develop well-being services, innovation and education, to extend networks, to increase citizens rights and freedom, to increase co-operation between the public and private sectors and to share best practice. Häme Development Centre Ltd started to develop well-being

cluster co-operation model already in 2005 and since then, Häme Development Centre has made close co-operation between region’s actors like municipality, entrepreneurs and other organizations. Co-operation has been made by sharing best practices between different actors but also between different regions. Häme Development Centre is still responsible for the development for the well-being cluster in Hämeenlinna region and the work is going on. Forssa Region Development Centre Ltd is responsible for the development of the well-being cluster in the Forssa region until 2013. The aim of this cluster programme is to improve competi-

T HEM E 6 . | S ER VICE P ROCUR EMENT, PURCHASE PROCESS | UMEÅ, SWEDEN

level, endorsed by a regional actor rather than a municipality. In the Västerbotten region there seems to be a regional movement towards these kinds of cooperative networks which further strengthen the possibilities for transferability. Short-term effects In the short term, one of the main effects would be the develoment of a common understanding of the different roles and responsibilities of the actors within the well-being sector. A common ground could then lead to dialogue and sharing; preventing competition for the same space and commercial niches in areas where this is not desirable. tiveness and companies’ capacity in the area but also to safeguard the availability of an educated workforce. Increasing innovation procedures, internationalisation and the strengthening of commercially effective networks will be done together with other cluster programmes. The emphasis of this development process is as follows: care, technology, environment, energy and green logistics. The achievements are mentioned as follows: 1) To develop business activity with the help of cluster managers, 2) to define business activity programmes to support growth and competitiveness, and 3) to develop innovation between different actors to strengthen commercialisation. Strengthening the image of companies in the well-being sector and persistent support for the growth of companies are essential tasks. Co-operation and the application of new information are crucial. When developing the well-being sector, co-operation between the public, private and third sectors is particularly important. Cluster managers handle tasks as follows: 1) branch development, 2) development of co-operation networks, 3) development and support of companies’ competitiveness and expertise, 4) coordination of innovation and internationalisation. The well-being cluster in the Forssa region arranges education, seminars, excursions and theme days according to different needs or current events. Clusters have tightened and intensified sector development in the Hämeenlinna and Forssa regions. They have combined different actors together and created strong networks between different sectors. As a result of the well-being clusters, expertise has increased and new kind of co-operation and business activities have been created. EVALUATION Umeå Municipality needs to cooperate with both the private and the third sector, but often the cooperation is focused on one question or one set of issues at a time. This is a good way of cooperation for these specific questions and sets of issues, but we tend to miss possible cooperation opportunities and exchanges of experience concerning questions that are outside or that cut across the specific area of the cooperation. Clusters such as the Hämeenlinnan and Forssa Well-being Clusters could allow transparency for the type of questions that cut across all three sectors and enable roles and responsibilities among the private, public and third sectors to be discussed and clarified for the organisations themselves and for the citizens of Umeå. The cluster could also allow for new ideas and new forms of cooperation as different competencies and interests meet. Transferability The transferability of the main features of the Well-being Clusters can be seen as quite promising as there are some existing networks in Umeå, although they are separate at the moment. To achieve the same results as the Hämeenlinna and Forssa Clusters we think that the cooperation needs to be at a regional

Long-term effects Clear roles and responsibilities are also effective from the longterm perspective as the actors within the well-being sector can focus on what they are responsible for and best at. Cooperation across issue boundaries can enable a sharpening of the specification of demands on quality, which will lead to even more qualitative efforts carried out by public, private and third sector welfare service providers. Cost effectiveness A functioning cluster should have some kind of appointed coordinator who is responsible for meeting agendas and summoning the participants. The cost for the coordinating role could be shared among the organisations with legal responsibility for the cooperation between the sectors, such as the municipalities and public regional actors. The coordination of such a cluster would not be overly extensive and could fit within the regular tasks of a public officer, for example. Possibility for innovative initiatives At its best, open and full cooperation could produce new ideas and new connections which could lead further to new business opportunities and business partners. One key to success could be a coordinator with competence in both the main legal responsibilities of social welfare services and knowledge about the regional priorities that could bring all this together to the cluster in order to create competition advantages for the region. End notes To obtain a functional and effective cluster in Västerbotten, the purpose of the cluster must be carefully described and the participants carefully chosen for their specific role within the well-being sector. The size of the cluster must be decided upon and weighted, the wider the focus of the cluster the more participants, but a large and all-embracing cluster could run the risk of pushing away the smaller business and association units that work close with older people in need of support and care. These choices would have to be made by the organisation that coordinates the cluster and have the responsibility to engage the public, private and third sectors in a cooperative way regarding health and social care. To further strengthen the cluster, it could be useful to involve citizens and care receivers and their relatives in the cluster in some way. Some non-profit organisations do work solely to represent a specific group of citizens, but in order to gain knowledge from those groups not represented by various organisations a wider perspective could be used. The most important factor of success for a Västerbotten Well-being Cluster would be that it is coordinated by the right organisation with the responsibility for joining the sectors together to create value for the region. To further endorse this best practice in the Västerbotten region, the next step to take would be to identify the best suitable organisation to coordinate the cluster.

EF F ECT COMMON CONCLUSI ON

Effect common conclusion

common experience of the almost two years spent working together is that we all share the same future challenge – to be able to attend to our older people with respect and to enable independence in an ageing population. Some challenges can be tackled by adopting best practices that have been tested and evaluated in a different region in Europe; some challenges must be met with specific solutions in the specific region. No matter how the challenges will be handled, there is almost certainly someone out there that has already tried a range of different solutions and gained experiences from them. The chance to broaden the network of different competencies and knowledge throughout Europe has given the Effect

partners many new ideas and perspectives. As shown in the best practice analysis, there are many ongoing exchanges of experience that have been made possible within the Effect project; and there is a great deal of potential interregional cooperation in the future. The conclusion of the best practice toolkit is only the beginning of the work that will be started throughout the participating regions – adapting and developing the best practices identified and analysed to deal with some of the most acute challenges within each region. Together we are able to better answer the challenges and demands faced by the ageing population. Together we are more EFFECTive!

Conclusions of Asturias’ theme • The ageing of Europe’s population implies a change of scenario, which offers challenges and potential opportunities for the sector in light of demographic and societal changes across Europe. • The new needs of elderly people require the evolution of existing services as well as new solutions in order to provide an effective answer to these new needs. Almost limitless opportunity exists for the development and delivery of new products and services to our burgeoning ageing population. • The Effect project has allowed us to verify how the different management models work in each country – public services, private or mixed public/private – providing new management approaches for consideration. • Despite differences in political approaches and institutional frameworks, health and social services in European Member

States face similar challenges. Nevertheless, the solutions and services are different, following the cultural and economic reality of each country. However, it has been confirmed there are best practices that can be successfully transferred to other regions. • The workforce engaged in the field of the ageing population is characterised by the involvement of multi-disciplinary professionals from diverse fields, different profiles and environments. This fact suggests that cooperation and work in collaboration is crucial in order to achieve efficiency. • One of the most important conclusions of the Effect Project is the need to improve training in the field of ageing: demands for professionalisation; the introduction of quality standards; technological solutions which require new qualifications; changing formal job profiles, etc. This should cover a broader range of skills giving a greater degree of flexibility.

Conclusions of Brescia’s theme The exchange of experiences through the Effect project among the five participating regions has been the first to be implemented at international level, as far as Comune di Brescia is concerned. The final best practice analysis has been particularly fruitful, leading to the identification of some initiatives that can be transferred into our territory, although some adjustments may be necessary (especially when taking into account territorial peculiarities as well as the history of Brescia’s services in the field of health and social assistance to elderly people). In particular, the projects that have been selected among the “most transferrable ones” under our theme aiming at the following objectives are: 1. Planning preventive actions addressing the elderly population; 2. Fostering better access to better services and other purchase solutions (i.e. senior cards); 3. Better use of the residential structures in the territory. Recommendations for further development of those projects can already be drafted as follows: 1.Planning preventive actions The project buon vicinato (“Good Neighbourhood”), which has

been active since 2004, can be further developed: so far the monitoring network addresses frail older people (those aged over 75 who live alone (without relatives living in the same area) and who are not social services clients). So far, 5,000 individuals in our territory have been targeted. This projects excludes “semi-frail” older people, who do not represent a risk now but do represent a potential risk for the future, thus requiring monitoring. Work carried out in Umeå suggests that the introduction of this category should be monitored by a qualified social operator. Agreements with universities could be established to better include and analyse those categories, or a call for proposals/tenders for voluntary organisations could be launched in this field. From a strategic point of view, it seems necessary to adopt a more proactive approach which should also be applied in the domain of policy making. 2.Better access to better services and other purchase solutions Senior Cards already existed in Brescia, offering older people with discounts in a specific network of shops in the territory, mainly in terms of food and beverages. The French best practice provides privileged access to a wider range of products and services, not only for the purchase

EF F ECT COMMON CONCLUSI ON

of food but also to a set of service providers such as plumbers, painters, etc. which are very useful for the older population and that should definitely be taken into account for further developments/pilot phases of new “senior cards”.

assigned when the family was larger). This situation generates a non-homogeneous distribution that should be revised according to requests by larger family units. A survey also guarantees an updated vision of the ongoing situation.

3.Better use of the residential structures in the territory The French best practice suggested that we should perform a survey of the real estate in public ownership, to improve the accommodation that could be suitable for older people. In Brescia the number of residential structures available is high (approximately 2,500 units), so carrying out a survey could lead to the optimisation of these resources. Additionally, many larger units in Brescia are currently occupied by single older people (in most cases this occurs when the unit in question has been

Ending: Effect has been a very interesting project, with real potential for further developments that could be applied in our territory. Our best practices selection from among the projects that have already been implemented in our territory (B.I.R.D., good neighbourhood, senior card) is in view of concrete further developments and actions that are already developed and could be fine-tuned or adjusted, in view of a rationalisation of financial resources which are lacking due to the financial recession.

Conclusions of Häme’s theme Häme Development Centre Ltd. coordinated the Effect project. Häme Development Centre Ltd. provides the Hämeenlinna subregion with a full range of business services. Their mission is to develop and improve the region’s entrepreneurial and competitive climate. Effect had a strong cooperation network in the Häme region, with many private and third sector stakeholders and Hämeenlinna municipality. This supported the Häme theme, which was “Cooperation between public, private and third sector actors in well-being service production”. From Häme’s point of view, it has been very beneficial to share knowledge and experiences between the participating regions and organisations. It is important to realise that we don’t have to reinvent the wheel, we can learn from each other. The ageing population is a challenge but also an opportunity – we can learn from different approaches to demographic change within Europe. Cooperation between different actors, regions and countries will become more and more important in the future. The best practice analysis under Häme’s theme was interesting

and led to the identification of some initiatives which could be transferred to the Häme region. In addition to this, we learned a lot about the best practices collected under other EFFECT participant themes. Those practices could also be transferred to the Häme region with some adjustments. It is important that we find more flexible solutions and customer-oriented approaches to elderly care in the future. “The future service needs of elderly people in the Hämeenlinna region survey” was conducted in the Häme region in 2011. The aim of the survey was to explore future service needs in the region. The results are used to identify guidelines and ideas which could help to create successful business opportunities in the Hämeenlinna region. Cooperation must be in everyone’s interest. Improved cooperation between all sectors will cause improvements and increase entrepreneurial activity, help to find a competitive advantage and strengthen networks and service chains within the region. Cooperation helps to utilise synergy benefits and to achieve efficiency in well-being service production.

Conclusions of Lorraine’s theme The Lorraine region has decided to participate in the Effect project, due to the fact that the ageing population is a very important issue with a variety of scales and impacting themes. This issue covers many fields, from health systems, intergenerational links and the evolution of the economically active population to housing and new markets, which usually come under the banner of the silver economy. Moreover, Lorraine will be, amongst the French regions, one of the most affected in the coming decades when considering statistics on the ageing population. As a regional public authority, the Lorraine region’s role and duty are, amongst others, to increase public awareness of this issue, initiate, organise and accompany collective projects with its different partners. Lorraine has chosen to increase public awareness by taking a multi-themed approach and, in addition to working more specifically, for the Effect project, to work on the link between the ageing population and the enterprises approach. This includes a definition of questions and challenges to be taken up when considering enterprises and the ageing population (for instance the silver economy), needs for new services

and continuous training, transfer of businesses, etc. Defining “sub issues” using the enterprises approach must benefit all the partners and feed their own reflections and studies. It also includes an identification of practices that can raise interest in other regions and lead to potential transfers, for instance practices within companies linked to senior employees. In the same way, Lorraine benefits from sharing and benchmarking experiences and activities through the evaluation of other regions’ practices. In general, this is related to the cooperation between public authorities and the private sector. As a general conclusion on the participation in the Effect project, we would like to underline that immediate and shortterm effects bring about significant advantages: it allows for awareness, the first and most essential step for moving forward in the improvement of public policies and in the definition of new initiatives, projects and policies. In the medium to longer-term, it certainly facilitates cooperation and collaborative work at the European level, thus allowing for dealing more effectively with demographic and social evolution.

EF F ECT COMMON CONCLUSI ON

Conclusions of Metz’s theme CCAS of Metz decided to participate in the Effect subproject to share knowledge and experiences on the themes of housing, solidarity, the fight against isolation, information and proximity, mobility and accessibility. This theme of work in the municipal social services comes from a charter of ten commitments concerning, housing, social life and solidarity, and autonomy and mobility. This document was signed between the city of Metz, CCAS of Metz and their partners in October 2010. It has been quite easy to find best practices related to this theme within the collected best practices developed by Effect partners. The best practice of Commune of Brescia (Lombardia region, Italy), namely the B.I.R.D. small sheltered houses project, would offer an innovative concept: it would answer both to the needs of the elderly and those people at risk of social exclusion. The innovation lies in the fact that the problems faced by these two vulnerable groups can be treated together. It is very interesting to seek to resolve the same difficulties faced by different people together rather than treating the problems by population. This practice could be easily transferred. “Welcome in” , a social meeting spot and café for adults and senior citizens in Umeå (Västerbotten region, Sweden) is a really innovative practice because it offers a meeting spot not

only for older people but also for younger adults. It is important to have places which allow the younger population and retired people to meet. This kind of place enables older people to feel included in society. What is also very interesting is that activities are also co-arranged by the visitors, which is good for maintaining autonomy and stimulating social interaction. The transfer of this best practice could breathe new life into the associations dedicated to older people. Well-planned quality housing research in Forssa (Forssa region, Finland) could bring about many benefits to a city by giving older people the opportunity to live at home for longer and to live in an autonomous way in the city centre near shops and services. This best practice is really interesting for a city like Forssa, which has many empty flats in its central area. It is a real opportunity to create adapted housing for elderly people and to allow them to live independently for as long as possible. It also brings activity to the private sector and particularly to companies that work to adapt accommodation to suit older residents. These three best practices are examples of transferable experiences because they do not require any legislative adaptation, which is a real barrier to transferability from one country to another. Sharing knowledge and experiences is very positive but it can also lead to disappointment if legislation prevents transferability.

Conclusions of Umeå’s theme The Umeå municipality theme within Effect has been a rather difficult theme to explain. Nevertheless the three best practices analysed can be described as examples of three important components of a qualitative public procurement model: demands on quality; cooperation; and flexibility. The Oviedo best practice “Best practice guide care homes for elderly” is a good example of work driven by demands for quality and end-user focus. The emphasis of the best practice guide is to learn from each other and the creation of a working culture that promotes the sharing of experiences. This approach is easy to adopt and will promote many good side effects within the municipality. The other important component of service procurement and public purchase is the cooperation between the municipality and the public and private actors that provide social welfare services. In the Finnish region of Forssa, a well-being network with private, public and third sector actors has been working to

ensure an end-user focused approach on the services provided within the region. Such a cluster could be set up in the Västerbotten region as well, allowing for transparency the clarification of roles and responsibilities among the private, public and third sector actors. The third best practice analysed by Umeå municipality is the Lorraine example of pension insurance welfare services – the tailor-made action plan (CARSAT NORD EST). This best practice focuses on the flexibility of an organisation to enable a multi-choice model. The best practice pinpoints the third important component with regards promoting the possibility of tailor-made solutions for older people in need of help and services. The three analysed best practices have contributed with ideas and knowledge about methods to promote demands on quality, cooperation between private, public and third sector organisations, and to make flexible solutions for the older generation.

Acknowledgements and contacts Asturias We would like to express our gratitude to all those who supported us in our work, in particular to the Inspection and Quality Service at Asturias Regional Ministry of Social Well-being. Contact information: Asturias Regional Ministry of Social Well-being - Inspection and Quality Service. www.asturias.es Brescia We would like to thank all the civil servants at Comune di Brescia, all the organisations and the volunteers working in this sector that helped to design and implement initiatives in the field of social and health care for older people. Contact information Dr.ssa Gabriella Bellini Responsabile Servizio Anziani Assessorato alla Famiglia alla Persona e ai Servizi Sociali Comune di Brescia gbellini@comune.brescia.it Häme The participants from Häme Development Centre would like to thank all the identified best practices in the Häme region for their willingness to share their experiences and good ideas. We would also like to thank Hämeenlinna municipality for their active participation and all the other stakeholders in the Häme region for their interest in the Effect project and its results. Contact information www.kehittamiskeskus.fi info@kehittamiskeskus.fi

EFFECT Project group EFFECT Project group Alain Piriou, CCAS Metz Andrea Rossi, Commune of Brescia Daniela Consiglio, Commune of Brescia Dolores Riestra, Oviedo Chamber of Commerce Egil Nylén, Umeå municipality Eija Tiura, Häme Development Centre Ltd Gabriella Bellini, Commune of Brescia Gloria Costeja, Oviedo Chamber of Commerce Katarina Jensstad, Umeå municipality Kristina Larsson, Umeå municipality Isabelle Letellier, Regional Council of Lorraine Marjo Nieminen, Häme Development Centre Ltd Ria Laurila, Häme Development Centre Ltd Yolanda Corrochano, Oviedo Chamber of Commerce

Lorraine We would like to thank: • All the Effect partners • The French organisations identified for their best practices (Lorraine best practice) - CARSAT NORD EST - ARACT LORRAINE • The French partners and speakers at our conference-debate (18 June 2012) Ageing population: economic issues, impacts and opportunities - CRITT AGRIA LORRAINE - URIOPSS LORRAINE - DAFCO-ACADEMIE METZ-NANCY Contact information www.lorraine.eu/cms/contact pastel@lorraine.eu Metz contact@ccas.mairie-metz.fr Umeå The participants from Umeå municipality would like to thank all the identified best practices in Umeå and Västerbotten for their willing to share their experiences and good ideas. • Petra Henriksson and Sarah Lundberg, Multi7-project • Evy Gustafsson, Health and Care College in Västerbotten • Pernilla Abrahamsson, Innovation Gateway, Västerbotten • Lena Kapstad, Welcome in! • Marianne Peterson Bäckström, Preventive home visits Contact information www.umea.se/kommun socialtjanst@umea.se

European Union European Regional Development Fund