Finland: Follow-up on the increase in the nurse-client ratio in the long-term care system

Abstract

<p>In order to guarantee the quality of longterm care, the centreleft government passed legislation on the nurse-client ratio. However, the reform has encountered severe problems caused by the shortage of nursing personnel needed to fulfil the quality standards required by the legislation.<br></p><p>Due to severe shortcomings detected in the Finnish elderly care system, Prime Minister Sanna Marin’s centre-left government passed a bill on the nurseclient ratio in long-term care (LTC). Since 1 October 2020, the formerly recommended ratio of 0.5 has become legally binding: there need to be 5 nurses (including practical nurses, care and nursing assistants and physiotherapists) per 10 patients, in addition to non-nursing workers (e.g. those engaged in cleaning, cooking or laundering, who were sometimes counted as care personnel). This ratio should improve gradually so that from 1 April 2023, it should be at least 0.7 (Kalliomaa-Puha, and Kangas, 2021). Although the ratio has only been valid for a year, strong reservations have already been voiced concerning its effectiveness in ensuring good care for older individuals in LTC institutions. In some cases, the effects have in fact been the reverse. Care providers have not been able to hire enough personnel to meet the demands of the new ratio. In order to fulfil the new nurse-client ratios, they have been forced to reduce the provision of care. In other words, as a consequence of the new legislation, fewer places provide LTC even though the supply was already too low before the new law was passed.<br></p>