Annual Report • Mar 22, 2018
Annual Report
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Quality that benefits our customers
An engaging workplace
Building for the future
Our vision – empowering the individual
QUALITY AND SUSTAINABILITY AT ATTENDO 2017
ATTENDO IS BUILDING Modern nursing homes | 12
INTEGRATING CARE Mind the Gap – where generations meet | 20
There is no upper age limit for outdoor experiences
| 24
Filipino nurses are giving Nordic care a boost | 36
EVENTS IN 2017
1,886 beds in 54 new nursing homes.
Attendo started construction of
2,903 beds in77 new nursing homes.
– the best home care unit in Sweden according to the National Board of Health and Welfare's customer survey.
– was named Quality Health Center of the Year 2017 for its work to prevent diabetes and hypertensive diseases.
Share of customer's being satisfied or very satisfied
Source: Swedish National Board of Health and Welfare, municipal surveys
Six of Attendo's operations recieved 100% customer satisfaction in customer surveys in 2017
Attendo's life style nursing homes receives better marks than average on 10 out of 13 quality indicators in the National Board of Health and Welfare's customer survey.
Attendo's home care receives better marks than average on 10 out of 14 quality indicators in the National Board of Health and Welfare's customer survey.
Climate actions in nursing homes in Finland led to reductions of 4-6% in consumption of electricity, heat and water during 2017.
Attendo acquired Unika, an operation in Stockholm offering musicals, TV-shows and events for persons with disabilities.
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Attendo is the leading private care and health care provider in the Nordics, with operations in Sweden, Finland, Norway and Denmark. We are helping address many critical challenges to society. One such is managing the rising need for care due to an ageing population. We are doing it by building modern care homes and by running them with high quality delivered by competent and committed employees.
Attendo offers care for older people in nursing homes and in home care. In nursing homes, customers live in their own apartments with access to common areas.
Attendo offers care services for people with disabilities, homes for children with special needs, substance abuse care, and care homes for people with neuropsychiatric conditions.
Attendo offers services within primary care, specialist care and dental care in Finland. In primary care, Attendo operates health centres and is responsible for certain units, such as emergency care centres. Attendo offers staffing of medical personnel throughout Finland.
Since 2008, Attendo has built around 10,000 beds in modern care homes around the Nordic region, and carefully integrated them into the surrounding community. Over the last five years, every fourth newly opened bed in a nursing home in Finland and Sweden has been opened by Attendo.
Since over 30 years, Attendo has been a pioneer in quality development in care for older people in the Nordics. Our quality system AQ17 leads to a consistently high level of quality, and we regularly get better reviews than local authorities from customers and their relatives in customer surveys.
24,000 employees
Attendo's employees contribute to diversity in care that reflects the needs of today's and tomorrow's seniors. four out of five managers in Attendo are women, and our employees are satisfied or very satisfied with both their job and their managers.
4
Attendo has been working to improve care in the Nordics for more than 30 years. Our constant focus has been on empowering the individual, based on our values of Competence, Commitment and Care. We are now continuing to build sustainable care, with focus on the challenges of the future.
Our sustainability work is based on ongoing stakeholder dialogue, which has clearly indicated the three areas that are most important:
Attendo's key contribution to society is helping to relieve the shortage of beds in the care system. In the past five years, we have built almost one out of four new nursing homes in Sweden and Finland. In 2017, we increased the rate of operations established to a new record level of 2,903 beds under construction and we opened 54 new care homes.
In parallel, we are working tirelessly to improve the daily lives of our customers by further improving quality of care. We use a thoroughly tested model of systematic quality improvement and monitor outcomes through our own index, the "Quality Thermometer", to achieve that end. Activating older people and offering them meaningful activities – activities they actually want – is a vital element of all care services we provide. Attendo has a proud tradition of being pioneers and we are still testing new and innovative methods. A few examples in 2017 were mobile care, dementia teams in home care, a scrapbook with documentation to support families and battered women, Unika and the Funkis festival song contest, all of which are described in this report.
We also put tremendous emphasis on being an attractive employer and making sure our employees are satisfied with their job situations. Our employee surveys show high and stable results in these respects. When something occasionally goes wrong, we always look for the cause in shortcomings in our procedures, not individual employees. We are also working continuously to secure access to qualified employees. Providing language training in Finnish or Swedish to nurses from The Philippines who are then offered employment with Attendo, is one example.
In addition to these three focus areas, we have several long-term sustainability targets in the areas of environmental protection, gender quality, anti-corruption and human rights. We are intent on reducing our consumption of energy and other resources by means of efficient methods and modern operational and building solutions. We are working actively to elevate women into managerial positions, and four out of five Attendo managers are women. We apply strict Codes of Conduct to ourselves and our suppliers, and are committed to diversity in all parts of Attendo.
Demographic trends show that care needs are going to increase for many years to come in the Nordics and the rest of Europe. Attendo is helping society address these needs by solving problems, great and small, in order to create sustainable care for the future.
I would like to thank our employees who are working tirelessly to improve our quality in close cooperation with customers and relatives.
Pertti Karjalainen, CEO
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Attendo provides high-quality care and health care services according to customers needs and wishes. Our work is aimed at achieving the vision of empowering the individual, and is based on our values of competence, commitment and care. Attendo seeks to have positive impact across the entire value chain – for customers and payors, society, shareholders and employees.
We create value for our customers and payors (local authorities) by offering high-quality services in the main business areas of Care for Older People, Care for People with Disabilities, Individual and Family Care and Health and Dental Care (Finland), through having an attractive service offering and by offering stimulating work to our employees.
Attendo also adds value to society by establishing new operations that address the shortage of beds in care and health care. Attendo is a significant taxpayer with regard to both payroll taxes and taxes on profits in the country where they were generated.
Attendo engages in ongoing stakeholder dialogues to identify the most important values from a sustainability perspective. We work continuously to improve our contribution to society, to develop our quality and to be an attractive employer.
Attendo seeks to act responsibly and selects new employees and partners based on the same standards we apply to ourselves, according to the Code of Conduct and other policies.
Attendo operates care for older people, care for people with disabilities, individual and family care and health and dental care. The business is conducted in three models: Own Operations, Contract and Staffing.
Attendo sells qualified care and health care services to payors in more than 300 municipalities. Attendo participates in framework agreements, freedom of choice systems and operation of specific facilities. Staffing service and combination contracts are also offered in Finland.
Attendo is a significant buyer of equipment, technical equipment, supplies, food and consumables. We also have agreements with subcontractors for various service deliveries, such as cleaning services.
| Production capital | Human capital | Relationship capital | Intellectual capital | Financial capital |
|---|---|---|---|---|
| • Existing operations, care homes and premises • Equipment and supplies • Support systems, plan ning tools, documenta tion systems • Manuals and procedures • Quality management system for monitoring and continuous improvement |
• Experienced managers with a mandate to lead • Specialist skills such as nurses, occupational therapists, doctors, assistant nurses, values coaches, quality coordi nators, etc. • Continuous recruitment and spread of working methods • Continuing education, web training |
• Interaction with custo mers and procurement officers • Interaction with authorities, experience with applying for permits and starting operations that meet permit requirements • Close dialogue with decision-makers at the local and national levels |
• Values and brand • Framework for quality improvement and sustainability • Processes for new establishments and investments • Structures and processes for ongoing operations |
• Strong, long-term owners who are expe rienced at leading and developing companies • Access to market capi tal for acquisitions and other investments • The opportunity to take risks in connection with investments in new capacity and new methods |
Attendo has more than 24,000 employees and engages in continuous recruitment of skills. We offer working conditions in accordance with collective agreements and provide skills development, including online training.
Attendo has its own quality management system – AQ17 – to evaluate the outcome of quality improvements, finding new methods and spreading them. The quality management system is designed to prevent deviations in operations.
Attendo is engaged in ongoing efforts to analyse, identify and meet local needs for care and health care services across the Nordics. We work with local authorities, property developers and property owners to build new care homes.
Sustainability efforts within Attendo are focused on three main areas: development of society, quality in care and health care and our employees. These areas have been identified as the most important to Attendo and our stakeholders.
Attendo engages in continuous dialogue with the company's stakeholders: customers, patients and their relatives, payors, employees, suppliers, investors, politicians and authorities. The stakeholder dialogue results in greater understanding of expectations and provides input for potential improvements.
Attendo tracks satisfaction among customers, patients and their relatives through regular surveys, as well as ongoing discussion in day-to-day operations. The company always seeks to base its actions on the needs and wishes of the customer or patient. Employee preferences and opinions are discovered by means including employee surveys and through performance and development dialogues.
Materiality analysis is used to identify the issues that are most important to Attendo and the company's stakeholders. The most recent materiality analysis was based on a list of about 30 sustainability issues within various topical areas. The significance of each issue to stakeholders and Attendo was assessed.
The process led to three areas being identified as most important to Attendo's future sustainability work: development of society, quality of care and health care and our employees. Overall targets were defined for each focus area and relevant key figures were identified to measure goal attainment.
Several activities were carried out in 2017 to strengthen Attendo's position within each focus area. Key figures have been defined and implemented to enable quantitative follow-up.
As part of the development of society objective, Attendo's ambition is to lead the establishment of new homes to address society's needs for new beds within care for older people. Attendo reports this area as the number of new beds under construction, as well as new beds in own operations.
In the area of quality of care and health care, Attendo is striving to maintain and further improve its leading position in quality and customer satisfaction. The outcome is reported in the internal quality thermometer, which is an overall appraisal of the primary quality factors in all areas of Attendo.
The objective in the 'our employees' focus area is that Attendo will offer a stimulating workplace for everyone who wants to make a difference. Employee job satisfaction and satisfaction with their managers is reported on the aggregate level.
| Focus area | Objective | Key figures | Outcome |
|---|---|---|---|
| DEVELOPMENT OF SOCIETY |
Lead the establishment of new homes to address society's needs for new beds within care for older people. |
Number of new beds under construction. New beds in own operations. |
2,903 1,886 |
| QUALITY OF CARE AND HEALTH CARE |
Maintain and further improve Attendo's leading position in quality and customer satisfaction. |
Outcome in the internal quality thermo meter. |
85% |
| EMPLOYEES | A stimulating workplace for everyone who wants to make a difference. |
Employee job satisfaction and satisfaction with their managers on aggregate level. |
4.0 out of 5.0 3.9 out of 5.0 |
The need for modern, adapted homes for people with care needs is still rising. This applies both to nursing homes and homes for people with various types of disabilities. Attendo is establishing more new nursing homes in Scandinavia than any other provider.
Demographic trends are the primary reason behind the increasing needs. The proportion of people aged 85+ is expected to increase by 50 percent in much of the western world by 2030. According to the 2017 survey performed by the Swedish National Board of Housing, Building and Planning
50% more people aged 85+ up to 2030
(Boverket), more than four out of ten local authorities have a shortage of beds in nursing homes and almost six out of ten have a shortage of homes for people with disabilities.
The increasingly high standards of acceptable care are another reason behind the increased need. Knowledge about what creates good living condi-
Source: Housing Market Survey 2017 from Swedish National Board of Housing, Building and Planning
tions is still evolving. As a result, many existing homes can no longer be considered fit to provide optimal care to residents. Health and safety standards and modern assistive devices have also risen in pace with technical advances.
During 2017, Attendo stepped up the pace in establishing new homes, thus making it easier for local authorities to meet the challenges of providing nursing homes to more people.
Every new construction follows a carefully-worked process where Attendo interacts with various stakeholders to overcome local challenges.
"Each project starts with a thorough analysis of local conditions and needs. There are many factors that need to be aligned, building a new nursing home is a big investment that entail certain risk-taking," says Urban Thorén, director for new establishments at Attendo Scandinavia Care for Older People.
With the experience and contacts that have been built up over the years, Attendo can find solutions that are suitable for both local authorities and real estate developers.
"No local authority wants to have a shortage of beds. We at Attendo are experts in accelerating the construction process without losing focus on quality. We become an important partner that can help the local authority to reach its own goals and at the same time gain more satisfied citizens," says Veronica Myhrström, Business Developer at Attendo Scandinavia Care.
At year-end, Attendo had 77 nursing homes with a total of 2,903 beds under construction in Sweden, Finland and Denmark.
Every new care home built has been through a complex process where conditions are methodically examined and barriers eliminated. Attendo are experts at devising flexible solutions to meet the local authorities' needs for care services.
Every project starts with a needs analysis. Attendo carefully reviews the conditions, as well as current and future needs.
When the conditions are right, Attendo makes the initial contacts with the local authority, property developers and property owners. The first step is to meet with politicians and officials to ascertain the local authority's plans and find out whether they are interested in buying beds.
In addition to fast and flexible solutions, Attendo can often bring new ideas that the local authority might not have considered. If there is interest in establishing a care home, the work begins with drafting a concrete project proposal.
The next phase is to prepare a drawing of the building and a cost estimate. Only then can Attendo's board of directors decide on the investment. If it is approved, contracts are then made with the property owner and building contractor.
This is followed by a period during which the building process and appeals, if any, are managed so that construction can begin.
Attendo's lifestyle homes are designed to promote good health and well-being. It is often relatively simple to describe good health, but well-being is not always as easy to pin down, since it means something different to everyone. In designing our lifestyle concepts, we have gathered the best available knowledge surrounding what promotes well-being and put it together with various interests older people often share. The result is modern homes with unique interior and exterior environments that stimulate the senses and enhance quality of life.
Each apartment has space for furnishings according to the resident's preferences.
Fresh flowers, herbs and spices – like an outdoor greenhouse – are standard features of our Outdoor & Garden lifestyle homes.
Our modern nursing homes are carefully designed to harmonise with the surrounding buildings and create space for intergenerational encounters, at a preschool for example.
n Lifestyle homes n All providers
To make outdoor environments accessible, our nursing homes have spacious balconies that can be adapted to the seasons, usually directly adjacent to the common areas of the home.
what promotes well-being.
At our Culture & Entertainment lifestyle homes, it goes without saying that residents have the opportunity to play or listen to music, dance, or read, all according to their tastes and abilities
Moving away from home late in life, away from where you have lived for a long time and watched your children grow up, can be bitter-sweet. But the move often brings a sense of relief and joy at the prospect of breaking a pattern of loneliness and, sometimes, insecurity.
Lilian Hultgren, 93, is delighted with her decision to move to Attendo Kantarellvägen in Åkersberga in the outskirts of Stockholm. She used to live alone in an apartment in Farsta, on the other side of town, three floors up with no lift. Lilian's children and home care services helped as much as they could, but the days, evenings and nights seemed to become longer all the time, and she needed more help.
"It seemed like I just sat alone in front of the TV or in the kitchen once the children and the home care staff had gone. It was not much fun. Here, all I have to do is open my door and I have help whenever I need it and pleasant company," says Lilian, who has already made several new women friends at the home.
Lilian's little apartment is furnished with her cherished writing desk, her cosiest reading chair, her bookshelf, table and – of course – pictures and mementos. These include children's drawings and a tea towel from a trip to New Zealand. Lilian lives here, there is no doubt about it.
"I don't miss my old home. This apartment is my home now. It is lovely and I have the things that are important to me here."
54 new care homes
1,886 apartments
Attendo picked up the pace in 2017 for both initiating establishment of new nursing homes and opening new operations for movein, helping local authorities cut waiting times for care services.
Atotal of 54 new and modern care homes were opened during the year with beds for 1,886 customers in Attendo's Own operations. The majority of the apartments are in nursing homes in Finland and Sweden but Attendo also opened 349 apartments in a total of 18 residential treatment facilities and group homes.
In parallel, the establishment of 77 new homes was begun. Over the next few years, this will give Attendo the capacity to welcome an additional 2,903 people who need modern care solutions designed for older people, people with disabilities and people with other needs.
"There is already a crying need for various kinds of care homes in the Nordics and the need is only going to become more urgent in the next few years. This is our contribution to addressing the shortage of beds and helping local authorities cut waiting times for care services," says Attendo CEO Pertti Karjalainen.
l Opened l Started
Looking at the past five years, Attendo has accounted for almost one out of four new apartments built within the Swedish and Finnish care. Karjalainen believes the high rate of construction is going to persist.
"Although these levels are exceptionally high, we know there is tremendous demand for the care solutions that we at Attendo can offer. Our ambition is to remain the provider that contributes more than any other to overcoming the challenges of providing care to an ageing population."
There is already a crying need for various kinds of care homes in the Nordics.
n Attendo n Other private providers n Local authorities
ÅKERSBERGA, SWEDEN
Attendo Kantarellvägen in Åkersberga welcomed its first residents in October 2017. A well-attended open house with an arts and culture theme attracted many older people and other interested people who learned more about the home.
"So many aspects – everything from IT services to equipment, permit applications and staff recruitment to procedures – have to be dealt with before a home is ready for move-in," says local manager Christina von Segebaden.
Operated according to the "Culture & Entertainment" lifestyle concept, amenities at Attendo Kantarellvägen include a library and a movie theater. The nursing home has also initiated a collaboration with a nearby art gallery, Österåkers Konsthall at Länsmansgården, to create interesting activities.
"We have become involved as culture hosts in the Municipality of Österåker and regularly arrange cultural activities for our residents and other interested members of the community, which many older people and their families enjoy," von Segebaden says.
An open house was held in connection with the opening and about sixty visitors listened to a talk about the history of Länsmansgården and the surrounding area. It was a successful start and Attendo received many queries from older people who would like to move into the home.
The logs frame the building in a very special way, creating a setting that feels warm and welcoming.
RUOVESI, FINLAND
Logs are an ancient and tried-and-true building material that have stood the test of time. The material is com pletely renewable, which helps make the building more energy efficient over its life span.
Sustainable when Attendo builds a log nursing home
innovative solutions for care homes, when it comes
Attendo strives constantly to find new and
The logs also frame the building in a very special way, creating a setting that feels warm and welcoming. Building this way also improves indoor air quality. The scent of wood stimulates the senses, which usually fosters a sense of well-being in older people.
"This building represents a new direction in the con struction of nursing homes, but of course log buildings are very familiar to many older people. Most older people regard logs as a homely and familiar building material," says Lauri Korkeaoja, Attendo's head of communications in Finland.
It is no surprise that the first log-built nursing home will be seen in Ruovesi. The town is known for its sawmill industry and has a small-scale town centre. Local decision makers were very eager for the city's new nursing home to be built out of wood.
The building is being constructed in partnership with Honkarakenne, a construction firm that has specialised in wood buildings for the past 60 years. The building was designed by the architectural firm HIMLA.
"This will be the first log building of its kind. Logs have many positive qualities. There are studies that show that solid-wood buildings have positive effects on both blood pressure and stress," says Marko Saarelainen, CEO of Honkarakenne.
A total of 30 apartments in an area of 1,200 square metres Construction start in October 2017 Opening expected around June 2018
All Attendo nursing homes work actively to make the operation as efficient as possible, which includes keeping an eye on resource consumption. A new initiative in Finland to reduce energy and water consumption at nursing homes has already shown positive impact.
Achieving operational efficiency is a constant endeavour at Attendo, both when it comes to creating the best possible quality for our customers and in terms of long-term economic sustainability. All local managers are tasked with keeping consumption under control in the premises we use, regardless of the terms of the lease.
Roughly speaking, there are two models for leases at Attendo homes. The first is where Attendo pays "base rent" and pays all costs for consumption of water, heat and electricity in the building. In the second model, one or more consumption components, usually heat and water, are included in the rent. The latter model is more common in Scandinavia, but in Finland, most Attendo units in Own operations are leased on a base rent basis.
A project has been ongoing for over a year aimed at reducing consumption at about 40 nursing homes in Own operations in Finland. In the past year, the homes have taken several measures and have regularly reported their consumption of electricity, heat and water. The project has delivered clear results:
"The measures have had very good effects at the reporting homes. On average, they have achieved reductions of 4-6% on all parameters we track," says Nanne Hienonen, controller at Attendo Finland, who has been involved in the project.
| Consumption | 2017 | 2016 | Change |
|---|---|---|---|
| Electricity (MWh) | 11,400 | 11,900 | -4% |
| Heat (MWh) | 11,000 | 11,500 | -4.5% |
| Water (m3) | 95,000 | 100,000 | -5.6% |
– Scaling down of ventilation equipment to the optimal size.
– Procedures and training to reduce consumption of e.g., water.
– Implementation of measures as soon as new homes start up.
Attendo Vuoripirtti in Espoo has received a lot of attention for bringing a nursing home and a preschool together in the same building. This unique bridge between generations has had a positive effect on the older people.
Separate generations are literally sharing their daily lives in Espoo, a town in southern Finland where a nursing home and a preschool are located in the same building.
The operations cooperate closely, and preschool-aged guests are always welcome and used to spending time with the residents of Attendo's nursing home. The older people and the kids visit each other often.
"The children come over to show off the latest songs they have learned to their 'bonus' grannies and granddads, and we also bake together. The older people get a real kick out of joining in the children's outdoor games on the shared courtyard," says Attendo local manager Niina Suvanto.
There are 35 apartments in the nursing home, which specialises in providing care for people with various types of dementia and other psychosocial disabilities. The co-location with the preschool has had positive effects on the older people in several cases.
"Even though many of the people who live in the nursing home suffer from memory loss, they still remember the children's latest visit."
The operational model has sparked widespread interest. As a result, Attendo is planning additional, equivalent concepts in other parts of Finland. Experiences with lifestyle homes in Sweden, where nursing homes and preschools are located near each other, have also been good.
"We believe bridging the generation gap and creating meeting places where family members of all ages can spend time together is part of providing good care," says Urban Thorén, Director of Business Development – Own Nursing Homes Scandinavia.
Täby in Stockholm is one example, where Attendo is involved in designing a new city block that is planned to include a library, a preschool and a nursing home.
The nursing home and the preschool in Espoo are separated only by a light-duty interior door, so the building forms a cohesive whole and brings different generations together in a natural way.
Niina Suvanto also sees other advantages to the co-location, such as how the older people become 'bonus' grandparents for children who have none, or whose grandparents live far away.
Many families include both children and older people. For those in that particularly stressful period of life, having the same address for different generations is a modern solution.
Attendo's nursing home and the Touhola preschool both began operating in early 2017. Forty children attend the preschool and 35 older people now live at Attendo Vuoripirtti. So far, the experience of living side-by-side has been a joy.
"There have been nothing but positive reactions and we have had no problems related to the co-location."
A new city block is being planned in Roslags-Näsby in the Municipality of Täby, where a nursing home will share premises with an assisted living facility for seniors who need home help services, and a preschool. Attendo is a partner in the project, along with Svenska Stadsbyggen. Construction will begin in 2020 and is expected to be finished by 2023.
Design of the Trädgården nursing home, which will form a new block in Roslags-Näsby along with other facilities. The nursing home was designed by Svenska Stadsbyggen and Kod Arkitekter.
The Attendo Lillgårdsvägen nursing home is in the same building as the Pysslingen preschool. The children's play areas happily co-exist with the outdoor fitness centre and other activities for the older people
The recently opened Attendo Lillgårdsvägen nursing home in the Tungelsta district of Haninge, south of Stockholm, also offers apartments for couples. A preschool is located in the same building, and the playground is next to Attendo's outdoor fitness centre. The children are interested in the nursing home and enjoy visiting.
The Pukslagargården preschool is just across the courtyard from Attendo Pukslagarvägen in Gävle, adding verve and action in close proximity to the outdoor activities of the older people.
Attendo Pukslagarvägen is a recently built nursing home in Gävle. A lifestyle home under the "Outdoor & Garden" concept, it offers a beautiful, activity-oriented outdoor environment. Everyone who wishes to can garden, exercise in the outdoor fitness centre or simply enjoy a leisurely walk in the area. The Pukslagargården preschool is right next door.
Many nursing homes can seem cut off from the rest of society and are sometimes perceived as rather isolated institutions. The Mind the Gap café in Norway is one of many steps being taken to open the doors to Attendo's operations and narrow the generation gap.
Intergenerational encounters are a key part of the nursing home concept that Attendo has developed in Norway.
Mind the Gap is located in a shopping centre in central Romsås, just north-east of downtown Oslo. There are shops and restaurants, of course, but also the Attendo Romsås nursing home with 93 apartments for older people with varying care needs.
Attendo offers a complete café menu at Mind the Gap, with coffee, pastry and simple dishes. But it is also a unique opportunity for intergenerational encounters, as the older people who live in the nursing home can easily make a date to meet friends and family who are going to be downtown anyway for other reasons. A well-equipped play corner makes the grandchildren happy to come along.
According to Geir Hansen, market and communication manager for Attendo Norway, the café is only one of several examples of how Attendo is working to bring generations together and make activities at the operations open to all.
"It is a pleasant place where older people can see their families and feel more deeply they are still part of society," says Hansen.
Intergenerational encounters are a key part of the nursing home concept that Attendo has developed in Norway. The Attendo Paulus nursing home in central Oslo has received attention several times for its invitations to various activities, not least among them the home's own outdoor pub, the St. Pauli Biergarten, where visitors can enjoy a glass of locally brewed beer on hot summer days. Various types of performances are also held here, such as "Generation Song" and jazz concerts.
In addition to the café, Attendo Romsås arranges regular quiz nights, where neighbours and older people meet and compete against each other in quiz games with various themes. Attendo's nursing homes also lend premises that are not used on evenings and weekends to clubs and associations to create a sense of vibrancy and activity and shrink the distance to the surrounding community.
Mind the Gap opened its doors in March 2017 with a splash. Bent Høie, Norwegian Minister of Health and Care Services, was specially invited to cut the red ribbon at the opening.
The minister gave a personal address drawn from his childhood in Randaberg, Rogaland County. Høie talked about mealtimes as an essential aspect of a meaningful life, where people recharge mentally and physically.
"Eating is about much more than stopping the rumbling in your tummy. The kitchen table is a very important gathering place. For me, that table was where I was seen and listened to at mealtimes, something I also hope there is room for at this café," said Høie in his opening speech, where he also talked about the "Live all life" reform to enhance the quality of care for older people.
One of the measures the Norwegian government is taking is to schedule dinner at nursing homes a little later in the day to make mealtimes more attractive.
"When people eat a bit later, they eat more, sleep better, need less medicine and have the energy to enjoy activities that promote well-being," says Høie, who also hopes Mind the Gap will inspire many other nursing homes to open their activities to the community.
Various types of performances are also held here, such as "Generation Song" and jazz concerts.
Activities are an important part of everyday life at Attendo's nursing homes. We aim to offer a variety of activities on a daily basis. And, naturally, we tailor the programme to the needs and preferences of residents, to the best of our ability.
n Local authorities n Attendo
Source: National Board of Health and Welfare, Local Authority and Unit Survey 2017
The music thumps from the speakers and a troupe of residents dance with gusto, each sitting on a chair. It's time for sit-down Zumba, and instructor Ljubica Petrovska energises the group and gets everyone going.
"This is the most fun, most fabulous activity I have ever been involved in during all my years working in care for older people," says Anna Albrektsson, local manager at Attendo Varvsgatan in Malmö.
The dance is set to great music, often from the 50s and 60s, and the participants can't seem to help getting caught up in it. Activities for older people are often quite sedentary, but not this one.
"We are thinking about training a few staff members to become instructors so we can run sit-down Zumba in more locations. They really raise the roof," says Anna Albrektsson.
The "Health and Hoopla" concept at Attendo Kvibergsgatan in Borås encourages residents to participate in outings and other outdoor activities. Thematic weeks are also arranged four times a year, often centred on countries.
Thematic weeks, outings in the nursing home's own bus and delightful rides on the side-byside tandem bike are a few of the activities that residents of Attendo Kvibergsgatan in Borås enjoy the most. The Health and Hoopla concept embodies the entire operation and involves both residents and staff.
The concept was implemented a year ago and the health gains are obvious. Local manager Pernilla Gabrielsson talks about a conversation with a family member whose sister lives in one of the nursing home's dementia sections. The sister had not phoned his brother for several years, then suddenly one day he got a call from her and they could talk a while.
"We know that everyone feels better when they are active. Our residents have fun, they have gained more energy and they sleep better at night," Gabrielsson says.
Thematic weeks are also arranged four times a year, often centred around various countries, which involve the entire nursing home. When there was a Greek theme, there was Zorba dancing and a barbecue evening with souvlaki.
Attendo operates the Kvibergsgatan nursing home under a contract with the Municipality of Borås.
A special concept – "Health and Hoopla" – is being tested here. It gives the residents access to outings and other outdoor activities on a daily basis.
The home has seven sections with a total of 86 apartments for people with dementia or physical care needs.
A café, a senior centre, a fitness centre and a preschool are all located in the same building. We know that everyone feels better when they are active. Our residents have fun, they have gained more energy and they sleep better at night.
One of Attendo's goals is to offer interesting activities at all Attendo care homes. When the Norwegian Outdoors Association invited older people at the Attendo Romsås and Rödtvet nursing homes to camp outdoors overnight, planning started at once.
Norwegian Outdoors asked whether there might be any older people who would like to experience nature up close in connection with the annual #nightoutdoors activity.
"Interest in the activity was huge. Unfortunately, older people rarely have the opportunity to participate, but this shows that it is entirely possible with the right arrangements," says Jeanett Plesner, who works with culture at the Romsås nursing home.
"Once we were out in the woods, there was cooking over an open fire and a glass of wine for all who wanted to partake. Towards the evening, there was guitar-playing around the camp fire before it was time to crawl into the tents to stay the night outdoors."
Jeanett Plesner adds that camping also adds new dimensions to living in a nursing home with high ambitions. "It shows that life isn't over just because you have moved into a nursing home."
With a digital leap at Attendo's nursing homes in Finland, the entire world was opened to the digital presence of older people. And the residents are enthusiastic about the new supersized Yetitablets and the opportunities they offer.
I n August 2017, Attendo introduced a Finnish innovation - the Yetitablet at selected nursing homes in Finland. The first pilot stage covers a total of ten nursing homes. They were a hit from the very first day.
"So wonderful to see you. I will always remember this," says a visibly moved Anni via Skype to her daughter, who lives in the US.
It has been more than a year since they last saw each other in real life. After a few months of contact via a Yetitablet, the communication has evolved into a weekly dialogue with the help of videoconferencing on Skype. Anni's daughter has also been able to easily discuss issues related to her mother with Attendo's staff and nurses.
A Yetitablet is a supersized tablet with the same features and functions as ordinary tablets. It gives older people access to a large library of software, including games and entertainment.
Daily activities are essential for people suffering from memory loss. A Yetitablet makes it possible to activate older people in a new way, based on their needs and preferences.
"Thanks to the supersized tablet, our residents have been able to do various things independently and it has also had positive impact on daily routines at the nursing home. For instance, someone with memory problems can be calmed
by using the tablet's app for stimulating the senses," says Anu Räikkönen, local manager of Attendo's nursing home in Ventelä.
In addition to communicating with friends and family, older people can also draw on their own or do fitness exercises while sitting in their chairs. The downloadable apps make it possible to play memory games and solitaire, do crosswords and lots more. Every tablet also has a full range of TV programmes with a save function, so the Yetitablet makes a conventional TV unnecessary.
The intention is to use the Yetitablet for communicating with family and friends, in rehabilitation, care and various forms of stimulating activities.
For people with disabilities, everyday empowerment simply cannot be taken for granted. But the Pict-O-Stat web tool is giving more people the opportunity to have an influence over their daily lives, regardless of their circumstances or disabilities. And more people can also share their opinions in customer surveys.
I n autumn 2017, the Attendo Scandinavia Care business unit carried out their customer survey using the web tool Pict-O-Stat for the second year in a row. Response frequency and results both exceeded expectations.
"It is much easier for all customers to take the survey in electronic form. That applies to both people receiving Individual and Family Care services and people with disabilities who are provided services in an LSS operation. It used to be hard for a lot of people to complete the paper forms," says Attendo project manager Millie Lindroth.
"Before, many customers had to get help from a family member, trustee or member of staff to answer the questions. With this type of survey, many more people are able to take the survey independently after an introduction and, where necessary, they are given passive support from our employees."
The Pict-O-Stat tool provides platform-independent support for answering surveys, either in a web browser or an app. The interface can be individualised with graphic elements, which means more people can understand the questions and complete the survey on their own.
Attendo's results of the customer survey in Pict-O-Stat are uploaded to the national database kept by the Swedish Association of Local Authorities and Regions (SALAR), which uses the same tool. This makes it possible to perform national comparisons between local authorities and private providers, as long as they have used the Pict-O-Stat survey system.
The 2017 survey include operations in On-Call and Family and Non-Custodial Care, and they achieved consistently good scores on the Customer Satisfaction Index. Many integration services operations were discontinued during the year due to fewer placements by the Swedish Migration Agency, but for those that are still in operation, the results were very good. In their place, Non-Custodial Care services have increased and those operations also achieved very good results in the year's survey. Overall, the scores have increased since last year.
The responses from operations in Care for people with disabilities (LSS) show very good results across the board. The number of respondents in the 2017 survey nearly doubled compared to the year before. In part, this is because the local operations are more comfortable with the web-based survey system, but also because many customers were already introduced to the electronic customer survey in 2016.
As a function of the higher response frequency, however, the Customer Satisfaction Index dropped from 90% in 2016 to 81% in 2017, but remains at a very high level. And a full 75% of customers would recommend Attendo, which is an excellent outcome.
"The more we can increase the individual's opportunities for personal empowerment and influence, the more we will be able to increase the capacity of operations to meet the person's individual needs," says Millie Lindroth.
It is much easier for all customers to take the survey in electronic form.
Pict-O-Stat is a web-based survey tool that can be accessed from any internet-connected computer, touch screen, touch control (a control button that is touched instead of pressed), flexiboard (a keyboard whose keys can be adapted to the customer's abilities) or smart phone. Pict-O-Stat is also available as a mobile app.
In 2016 and 2017, all operations within Attendo Scandinavia Care carried out their annual customer surveys using the new tool.
The surveys are generally designed for Individual and Family Care, while the LSS operations adapt the surveys for each individual, so each person is provided a personalised survey, which is a prerequisite for being able to take the survey.
Many people are affected by dementia disorders later in life. Aimed at improving the quality of dementia care, Attendo has introduced central dementia teams to spread specialist knowledge among nursing homes. In addition, all dementia care homes must be part of the Swedish national BPSD register to contribute to improving knowledge.
160,000 people in Sweden are living with a dementia disorder.
Everything we do is personcentred. That means our interventions are always based on what makes the individual feel better,
About 160,000 people in Sweden are living with a dementia disorder, which affects both physical and psychiatric health. Many people with a dementia diagnosis are troubled at one time or another by anxiety, aggression, apathy or eating disorders.
To improve quality of life for these individuals, care must be tailored according to the person's circumstances. The Swedish BPSD register is an effective tool that was recently granted SEK 1.5 million by the Government to increase expertise on care of people with dementia.
Attendo's dementia care concept is called Share the moment – Personcentred dementia care®. The concept addresses the things that are important to remember in care provision and the care setting to create a calm and peaceful atmosphere. Attendo works in multiprofessional teams made up of a contact person, nurse, physical therapist, occupational therapist and a BPSD administrator. Behavioural problems and psychiatric symptoms can be prevented through the combined expertise of the team.
This might involve, for example, determining the best way to soothe and distract an individual who becomes profoundly anxious every day at a particular time, which makes them feel they must get out and go somewhere. To identify a solution, the team gets together and reviews the various parameters in the BPSD register and then arrives at suggestions for solving the problem: perhaps, for instance, some kind of activity that is done regularly and in a similar way can reduce the anxiety.
The team registers care interventions: what they do, how many times per week, for how long and at what time of the day in order to clarify and make it possible to follow up whether the intervention has had effect on the BPSD symptom. "Everything we do is person-centred.
BPSD stands for Behavioural and Psychiatric Symptoms in Dementia. The aim of the BPSD register is to apply interdisciplinary care interventions to reduce the frequency and severity of symptoms and thus the suffering of people who are affected by dementia. The register is based on National Guidelines issued by the Swedish National Board of Health and Welfare and is intended to assure the quality of care provided to people with dementia.
That means our interventions are always based on what makes the individual feel better," says Birgitta Svensson, a nurse at Attendo and certified trainer of new administrators of the BPSD register.
It starts with basic needs like food, drink, sleep, digestive health and pain relief. Naturally, reviews of prescription medicines are also important. Quite often, it may be necessary to cut back on certain medicines that are not good for people with dementia or increase dosages of pain medication if the patient is uncomfortable.
"The team also works in a structured way with the various symptoms in the BPSD register. That means everyone speaks the same language and proceeds from the same issues, which prevents resorting to unsupported opinion," says Svensson.
When Linköping University Hospital was overloaded and needed short-term accommodation fast, Attendo started a ten-bed facility in only 14 days.
The short-term accommodation, which was run on the 18th floor of the main hospital building, started out as a trial run for six months and was later extended to nine months. The idea was to link nursing and care for older people to create a safe place where patients whose treatment was complete could be prepared to move home again.
The facility was equipped by the hospital and Attendo brought in its own staff as well as some equipment. The trial was a success, due largely to smooth and close cooperation between the Municipality of Linköping, Region Östergötland and Attendo as the provider.
"I believe this type of flexibility is the future. Being able to get an operation up and running rapidly when the demand arises is good for everyone," says Gun Karlsson, regional manager at Attendo.
Attendo has many years of experience offering individualised care for people with various types of disabilities. There is a wide variety of programmes and activities, everything from TV shows to an inn.
At Attendo Unika's daily activities programme and short-term accommodation home, creativity and stage production are front and centre. The 150 artists work every day rehearsing for upcoming performances or TV and video filming. They are involved in dance, makeup, music production and work behind the scenes.
"Everyone is involved in the rehearsals and the pace is fast. The most fascinating thing is the joy the artists spread to everyone around them. They have so much fun and everyone's in top gear all the time," says Marica Westin, local manager at four of the seven units.
Attendo acquired Unika (meaning 'Unique') in February 2017. The target group for the daily activities programme is young adults, and for the short-term housing, young people age 12 and up, all with mild to moderate learning difficulties or autism. The employees are professionals in dance, drama, singing, light and sound and direction, and are on hand to provide support as needed.
A typical day on the job might include an interview for Unika's own TV show. In 2017, celebrities including Lill Lindfors, David Hellenius, Özz Nujen and Lasse Åberg have walked Unika's red carpet to be grilled on the TV sofa.
The most fascinating thing is the joy the artists spread to everyone around them.
Attendo Nysättravägen is a recently built care home for people diagnosed with Prader Willi Syndrome, (PWS), a chromosomal defect that in very simplified terms causes a lack of or reduced sense of fullness, and so constant hunger. The diagnosis is so rare that there are only three care homes for the same purpose in Sweden, two of which are operated by Attendo.
"The complexity of care provision is based both on the various challenges of the syndrome and the psychosocial aspects," says Cecilie Klemetsen, local manager for both group homes, Nysättravägen and Ljusnevägen, and continues:
"The number one success factor is a high level of expertise on PWS in the staff team throughout the process, which applies to everything from planning the design of the group home to assessing the residents' care needs."
A great deal of planning is required to effectively deal with residents' meals while trying to divert their focus from food to other activities. All cooking is done during the night and an advanced exhaust fan system has been installed in order to subject the residents to as little cooking smells as possible. Planning is done in consultation with a dietician.
We really get great reviews from our guests, who think it is incredibly fun to stay with us.
Örkelljunga Bed & Breakfast is a new operation with 20 beds located in Örkelljunga, an area of outstanding natural beauty featuring nearby hiking trails, canoeing and fishing. The guests are everything from conference attendees to outdoor enthusiasts on fishing or canoeing trips.
"We really get great reviews from our guests, who think it is incredibly fun to stay with us. We already have several regulars who come in for lunch almost every day. We've also had guests from further afield, including Australia and England," says local manager Tomas Wallberg.
The B&B was fully booked almost all summer long and in August 2017 the business was expanded with an inn. The business is run as a daily activities programme by seven people entitled to service under LSS, who do everything from welcoming the guests to laying the tables in the restaurant and keeping the rooms clean and tidy. They are assisted by two care educators and a chef.
"They are truly proud of their workplace and love to sit down and chat with guests at breakfast or lunch, which just adds to the charm of the place."
Traumatised children often repress their experiences when they are placed in a foster home. To help children remember, Attendo has introduced a new kind of documentation that focuses on the child's positive experiences.
T he documentation is called "My Time with the Family" and is a concrete assignment to the foster family for some of the children placed in Attendo's foster homes. The assignment is to collect and document the child's positive experiences during the placement. The foster family is also asked to write down their positive assessments of the child during their time with them.
"We want to give the child a more complete picture of what they have been involved with during the period they were in our care. Even if being
placed in care was itself traumatic, a lot of good things also happen in care, which can balance out the child's negative experiences. We want to reinforce the positive aspects to make it easier for children to process their experiences and remember the bright spots," says Marie Kjellqvist, local manager of Attendo On-Call & Family in Stockholm.
Children are often placed in foster homes due to a serious incident that may linger as a trauma even much later in life. The child may have been exposed to violence, assault or various forms of neglect related to substance abuse or mental illness, for example. Children who have experienced trauma often have reason to revisit the trauma and deal with it later in life. According to Marie, the only documentation available is usually the records kept by Social Services, which are often scanty.
"Besides the fact that their documentation is focused on the exercise of public authority, there is often a great deal of material that is confidential. For that reason, when these children are adults and want to go back and clarify what they experienced, this documentation may be of little use."
With "My Time with the Family", the foster family instead collects photographs and experiences and writes down assessments as a sort of scrapbook about a placement. Two carefully laminated copies of the scrapbook are made - one for the child to take with them when they leave, and one that is sent to Social Services for registration. The hope is that "My Time with the Family" will help the children put together a clearer picture later in life.
"Even if the child is perhaps not interested immediately after a placement, this makes it possible for them to go back and retrieve documentation of what they were involved in from the positive perspective of the foster family," says Kjellqvist. "We hope this will be valuable to people who are looking for answers later in life about what they experienced as children."
Attendo Vilhemsgården, a sheltered housing facility for women and their children, is located at a secret address in Västerbotten. The building is fitted with a security alarm system and has an entry code, the windows are unbreakable and all meetings with external parties take place elsewhere. In spite of the high security, the environment is homelike and there is even room for a pet or two.
Vilhemsgården, a sheltered housing facility, is located in an apartment building where the women and girls live either in groups or in their own apartments. The women who live here have been subjected to intimate partner violence, family honour or gang-related violence, human trafficking or similar crimes.
The staff at Vilhemsgården work in teams assigned to each woman or girl and her children, if any. The team is made up of a contact person, a child advocate and a social worker, who are jointly responsible for issues including police reports, contacts with government agencies, daily life at the home and protection. Based on an agreement with the social services office, danger assessments are carried out at the facility. The team is also responsible for crisis support and therapeutic conversations with children.
It is not unusual for the women to normalise and trivialise the violence and return to a destructive relationship. That is why the conversation is so important, to put what has happened into words.
"One of our most important tasks is to get the women to understand what living under protection entails," says Cathrin Bergqvist, local manager at Attendo Vilhemsgården.
"Making a police report and leaving your ordinary life behind is an unreal situation, since everything that you took for granted is simply gone. We talk a lot about this and go through everything that has to be kept confidential in the future."
The children who come here have also experienced violence and it is equally important to talk to them
about what has happened, to look for explanations and put thoughts and feelings into words. We also want to see the children go back to an ordinary life as much as possible and attend preschool or school. The teams work intensively with parenting skills and try to guide and strengthen the mothers.
Under contract with the social services office, Vilhemsgården also carries out danger assessments using the FREDA and PATRIARK instruments in order to identify violence, needs for support and protection, and risk of patriarchal violence with honour as a motive.
"In our experience, girls who have lived under honour oppression have been isolated and have no idea how people live in Sweden because they have no knowledge or experience of life outside the family. In some cases, they may even have lived double lives, where they have one role at home and another out in society, and where the two worlds never meet," says Bergqvist.
She continues: "The one thing they have in common is that the girls have carried the burden of the family honour. Once they come to Vilhemsgården, they have to leave everything behind and it is not easy to leave the people you love, lose your childhood and your context and learn to live under protection."
"Our job is to create the conditions for the girls to live a secure life where they decide about their own situations and create new relationships."
In addition to Attendo Vilhemsgården, Attendo has two other sheltered housing facilities: Attendo KrisTina in the Stockholm area and Attendo Villa Nike in central Sweden.
Nurses Ulla Lindbäck and Maria Karlsson chose care for older people and Attendo so they would have less stress and more influence over their day-to-day lives. Greater responsibility, yes, but also more freedom and moments of joy. And they do not miss hospital work one bit.
Early in my career, I felt the hospital wasn't right for me and that I wanted to work in care. When Attendo arrived in Eskilstuna, I said immediately that I would apply, and I have never regretted it," says Ulla Lindbäck, a nurse at Attendo Ekebyvägen in Eskilstuna.
She and her colleague Maria Karlsson are the care managers at a lifestyle care home with a total of 54 apartments. They both love their roles, which involve supervising three dementia sections each, but also responsibility for contacts with the health care system and families.
"As a nurse, you are part of day-to-day operations and supervise the staff. That requires presence, that you spend time with the older people and keep in touch with their families," says Lindbäck.
"At the same time, you have to plan services for every customer so that they get their medicines as ordered, and regularly
It's okay to cry a little when someone has passed away.
consult with doctors and occupational therapists. That is a fun part of the job, getting the residents to feel reassured that we understand their needs and will provide the services they need."
Maria Karlsson especially enjoys her role working with family members, even though it sometimes involves tearful farewells.
"It's okay to cry a little when someone has passed away. I think that is the most important part of the job, being the link between the customer and their families and making sure they are informed about the services we are providing and how their loved one's health is progressing," says Karlsson.
A typical day in a nursing home is very different from one in a hospital. In hospital care, everything was often planned down to the last detail, which both Ulla and Maria found stressful. There is tremendous variety in the nursing home
setting. The older people's state of health can change quickly, and the nurses' skills are often put to the test.
"It is a huge advantage to work in a setting where the days are not always the same, where you have the flexibility to switch between the routine and things that have to be done urgently. Should I take a blood sample today, or plan it for sometime next week? I make the decision based on the situation," says Lindbäck.
The role of care manager requires wide-ranging clinical experience. But for professionals who have grown weary of hospital work, there is a great deal to be gained, both in terms of working conditions and personal and professional development.
"There is so much variety, which makes it a fun and rewarding job. The encounter with the older people is what makes the job so fulfilling," says Lindbäck.
"And there is a lot of warmth, love and hugs — that is such an important part of the job," adds Maria Karlsson.
It is a huge advantage to work in a setting where the days are not always the same.
It sounded boring at first. But after five weeks of work experience, nursing student Tove Lundberg has a completely different picture of care for older people.
Attendo has been working closely with Mälardalen University in Eskilstuna for a decade. Nursing students are offered work experience placements at Attendo's Eskilshem and Ekebyvägen nursing homes twice during their educations.
Tove Lundberg from Stockholm spent five weeks at Attendo Ekebyvägen in the autumn of 2017. After her work experience placement, she has an entirely new picture of what it means to be a nurse in care for older people.
"It sounded boring at first. But it has been so educational because so much happens every day," says Tove Lundberg.
"I have gained huge respect for the people who work here. Everyone is very keen that we should all truly see the customer we are supposed to help. That is a perspective I will take away with me."
What surprised Tove the most during her placement was that she got so close to the older people and that she can clearly see every resident as the individuals they are.
"After five weeks, I already feel like I want to stay on. I can definitely imagine myself working with older people in the future," she says.
The nursing shortage is not a global phenomenon – there are thousands of unemployed nursing graduates in The Philippines. Attendo has been running a successful project for several years to offer these nurses jobs in Finland and Sweden.
At present, 86 trainee nurses from The Philippines are working in the Swedish operation and several are about to start local training at home.
Once they arrive in Sweden, the nurses receive further training, as well as work experience placements in a local operation. Thus far, all has gone according to plan.
"We are delighted to have recruited so many skilled and experienced nurses who quickly qualify for becoming registered nurses. In the best case, they will be able to work fully as nurses by springtime," says Carina Andersson, HR manager for Attendo Scandinavia.
The project to recruit Filipina nurses in the Nordics actually began several years ago. Through a joint initiative with a local partner in The Philippines, Attendo could offer about fifty nurses supplementary language instruction for a year. After passing a language test, most of them are sufficiently fluent in the language to travel to Finland or Sweden and contribute to care provision in regions where there are staff shortages.
We are delighted to have recruited so many skilled and experienced nurses.
It is very difficult to find a job in care and healthcare in The Philippines. Nurse Muriel Dela Cruz is one of those who have left their homeland for a new career in Sweden.
The Philippines is a developing country with a population of about 100 million. About another 11 million Filipinos live and work abroad. The healthcare sector is in a relatively poor state. Nurse Muriel Dela Cruz tells us, for example, that there is no guarantee that gloves and hand sanitisers will be available at the hospital, so staff often buy their own. There is no real system of care for older people, beyond a few costly private nursing homes for those who can afford them. Older people, abandoned and alone, are sometimes cared for by a charitable organisation.
"In our culture, adult children are expected to take care of their parents and other relatives when they get too old to manage on their own. Older people commonly live with their children," says Muriel Dela Cruz.
She relates that her own mother took care of her grandmother full-time for the last ten years of her grandmother's life.
"That is a heavy burden to carry and carers are at high risk of exhaustion and depression. I used to step in and relieve my mother so she could recover between times."
Muriel explains that many Filipina nurses seek work abroad, primarily in English-speaking countries. After finishing nursing school and a year working for an occupational healthcare provider in her hometown of Baguio, she saw an ad offering jobs in Sweden. She applied and was accepted.
Now, a year and a half later, she has found her way in the community and the workplace, as a nurse trainee at the Attendo Duvan care home in Linköping. She hopes to achieve her Swedish registration in May.
"I really love my new job. I have been given a lot of help settling in here and I have new friends whom I see when I have time."
Muriel is clearly passionate about her work as a nurse. A lot of people in her family work in healthcare, and she describes herself as "someone who likes to help others." In her view, the best thing about care and healthcare in Sweden is that it is modern and quick off the mark when it comes to development. She thoroughly enjoys every issue of a popular science journal published by the Swedish Society of Nursing six times a year, drinking in new knowledge and being inspired by fascinating research findings.
Learning the language was the biggest challenge related to the move, she says. Muriel took a oneyear Swedish language course before moving to Sweden and is still studying Swedish now that she is here. "But there is still room for improvement," she says in nearly flawless Swedish.
When people work with people, it is almost inevitable that things will go wrong sometimes. But deviations, complaints and serious incidents are always taken seriously at Attendo, so that procedures can be improved.
Attendo has been running a successful quality improvement project for several years, aimed at reducing the risk of errors and serious incidents. It involves continuously evaluating the outcome of the effort, systematically improving working methods and procedures, and gathering and spreading the best available knowledge about how the work should be performed.
When a deviation is discovered or reported, there is an established procedure for identifying and investigating the incident. Thousands of services provided to individual customers at Attendo are documented every day in the Attendo Add quality system, and every employee is encouraged to point out any risks or deficiencies in how risks are managed.
"Documentation is everything, and we are very good at it here at Attendo. We have a system in which we document and structure information related to each and every customer, every single day. As a result, everything is organised if we have to carry out an investigation," says Christina Mo, quality developer and medically responsible nurse at Attendo Scandinavia Care for Older People.
mentation of every customer, there are few serious incidents. But in an operation where people are working with people, situations nevertheless arise. "Unfortunately, there is always a human factor in
our activities. Misunderstandings or erroneous reporting may arise in our system, or procedures may not have been followed. The important thing is to quickly determine what went wrong and learn from it, not to point the finger at individuals," says Mo.
If a serious incident has occurred, or the risk of a serious incident has been reported, the first step is to decide to carry out an internal investigation. Procedures and documentation are checked and employees are invited to talk about their experiences.
"Time is a key factor. So, we are careful to start our internal investigations as soon as a deviation is discovered. It is especially important to clarify the course of events to arrive at a shared understanding of the incident before people forget," Mo explains.
Investigations are carried out by another manager in the region to which the operation belongs. As a result, knowledge is spread among various managers and an opportunity is provided
Thanks to the systematic effort and the docu-
Employees document the complaint, serious incident or risk in the operation.
investigation The responsible manager decides to open an investigation Another manager in the region is assigned to carry out the investigation.
Conversations with employees about the course of events Examination of procedures, documentation and handovers.
Decisions on changes to procedures and/ or the operation to ensure that the same error cannot be repeated.
In the case of a serious incident, a decision is made to forward the investigation to IVO for external audit under Lex Sarah/Lex Maria.
to also improve procedures at operations where nothing unfortunate has happened.
When serious incidents do occur, the incident is always reported to the Swedish Health and Social Care Inspectorate (IVO) for external audit, as required under Lex Sarah or Lex Maria. IVO examines whether the investigation was duly performed and whether adequate measures were taken.
"We usually receive very good feedback from IVO concerning our investigations and our forwardlooking measures. Although what happened cannot be undone, we nevertheless can show that we have done everything we can to make sure it does not happen again," says Mo.
The important thing is to quickly determine what went wrong and learn from it, not to point the finger at individuals.
Attendo always report serious incidents according to existing regulations. In Sweden, incidents are reported according to two legislations; Lex Sarah for care and Lex Maria for healthcare. With every reported incident, the responsible authority reviews Attendo's investigation and actions taken – typically without further remarks.
In Finland, incidents are reviewed by external parties on an ongoing basis. In 2017 there were two reported cases of mild criticism against Attendo and one case of a serious deviation.
In relation to all care actions documented in Attendo's quality system, the number of reported or criticized serious incidents corresponds to less than 1 per 1 350 000, which means that 99.99993% of all care actions are performed without calling for external review.
Procedures and systems work only if they are understood and followed by all employees. Quality assurance therefore involves both having uncomplicated systems and recruiting the right managers and employees. Fundamental changes, such as mental illness in older people, must also be considered.
"When deviations arise, it is almost always a matter of leadership. That is why it is imperative that we are able to recruit and retain good managers and that managers have the necessary experience and are able to get their employees to understand and follow existing procedures," says Christina Mo, quality developer at Attendo Scandinavia Care for Older People.
Increasing shortages of qualified workers has made the recruitment of managers an even greater challenge lately. That applies especially to the ability to recruit and retain nurses. There is an increasing shortage of workers in health and social care professions in general. Christina Mo notes that there are also challenges in communication related to the increasing diversity of employee groups.
Experienced managers can clear up language confusion, but training and simple, easy to understand reporting systems also help. For these reasons, quality developers are constantly working with new online training programmes and to simplify procedures to ensure more effective operations.
Monitoring the health status of customers who move into a care home is another challenge. Christina Mo concludes that many older people have to wait longer to move into a nursing home due to the shortage of beds and as a result are in poorer mental health when they arrive.
There is an ongoing effort at Attendo to identify mental health risks among older people, such as the risk of suicide, at an early stage. Procedures in the area will be reviewed and updated in 2018.
"Mental illness among older people is a growing social problem. We see this as an area where we need to get better at preventing incidents that may otherwise have serious impacts on both life and health", Mo concludes.
40 FOCUS ON EMPLOYEES
SALIH ORDULU, 30 YEARS WITH ATTENDO
Salih Ordulu got his first permanent job as a cleaner at Svensk Hemservice AB, the company that is now Attendo. In 2017, he was celebrated in style as the first employee to work for the company for more than 30 years.
Salih "Salle" Ordulu is now 55, and even though more than 30 years have passed since he started working for Attendo, he remembers clearly what it was like in the beginning.
"I remember my job interview, it was on the 24th of September 1987. After the interview, the managing director phoned me and said, 'Welcome to Svensk Hemservice, you can start on Monday'. I was so happy," says Salih.
He started as a cleaner at the Rio assisted living facility on Östermalm, a home that Attendo operates under contract. But it was a completely different company then, he points out.
"Back then, we were a small cleaning company. The managing director was called Kjell and every week he went around to visit all the employees and made sure we were happy. Sometimes we all got together for coffee in Liljeholmen. There were maybe 15 or 20 of us all together."
In 1988, Svensk Hemservice got its first contract to provide home care in the municipality of Danderyd. And that was the beginning of a period in which Attendo was gradually entrusted with providing care for older people under contract to an increasing number of local authorities. The business was expanded in the early 1990s to nursing homes, including Rio. Attendo has grown significantly since then and now operates more than 700 facilities under contract or in own operations across the Nordics.
Salih came to Sweden from Turkey in 1985 when the economy at home was in trouble. Most of his family still live near the capital city of Ankara. Once he arrived in Sweden, Salih discovered that it was hard to learn the Swedish language. For him, a cleaning job was a door into the labour market before he gradually transitioned to building maintenance starting in 2002.
He has held his current position since 2007. Today he is "Mr Fix-it" at the Attendo Kampementet and Attendo Solbacken nursing homes.
"I love going to work every day. The best thing is the freedom, that I feel free
I was gobsmacked. Has it really been 30 years? But it was a lot of fun to be made a fuss of.
1987–1997 Attendo Rio assisted living facility and nursing home on Östermalm
1997–2002 Attendo Alströmerhemmet and Attendo Hallen in Solna 2002–2007 Attendo Långbroberg in Älvsjö 2007– Attendo Kampementet and Attendo
Solbacken on Östermalm
to help out wherever I can. And I have great relationships with my supervisors and colleagues."
Having worked for Attendo for so many years and at several different workplaces, he has come to know many colleagues over the years.
"I have had so many workmates – I see them everywhere, on the bus, on the underground. I'm always hearing a 'Hiya Salle!' and it is wonderful."
But there is also a downside to the job, he admits. When a contract expires, many very effective teams are replaced.
"It is tough when you lose a contract and have to say goodbye to customers and colleagues. That is no fun."
Salih has lived south of Stockholm since 1995 in the family's own terraced house. He and his wife have five sons, aged 15 to 31.
"I am very satisfied with my job, and I don't think about the pay that much. The most important thing is feeling free and having good relationships with coworkers, being able to joke around with them. I do that every day."
One thing he regrets is that he did not become a shareholder in Attendo when he was first offered the opportunity.
"Well, when I met Henrik Borelius the first time in 2002, the company wanted to borrow money. They invited us to buy shares in Attendo. But I had a mortgage to pay, so I said no. I regret that a little now."
In October 2017, his anniversary was celebrated in style with a cake, presents and a personal thank-you speech from CEO Henrik Borelius. Marie Pilhjerta, local manager at Attendo Kampementet, set the stage by asking Salih to go down to the basement to organise old computers. When he came back up, he was greeted by the entire staff, who had gathered in the foyer.
"I was gobsmacked. Has it really been 30 years? But it was a lot of fun to be made a fuss of. That is a day I will never forget."
And Salih has no plans to leave: "Oh no. I want to be with Attendo when I retire."
The care sector is characterised by people of many different nationalities and backgrounds. At the same time, women are over-represented at Attendo at both the staff and managerial levels.
T here are many different nationalities among Attendo's employees in the various areas of operations.
"In order to offer high-quality, individualised care, we must have diversity among our employees that reflects our customers," says Carina Andersson, HR manager for Attendo Scandinavia.
"We believe it is important to have employees who understand what we mean by good care in the customers' native languages, because many people who develop dementia may forget the language they learned later in life."
There are several occupations in the care sector where the threshold to the job is relatively low. This can make it easier for people with weak ties to the labour market to get their first job. Many start their careers with simpler jobs in the care sector.
"It is gratifying that many people of foreign backgrounds often choose a career at Attendo, where they gradually build up their work experience with new skills and knowledge, which makes it possible for them to take on more responsibility and become managers," says Andersson.
Attendo's executive management is an example. Two top executives within Attendo Scandinavia, Ammy Wehlin and Cecilia Addamshill, have both gone all the way from social workers to business area directors. In both business areas, more than four out of five local managers are women.
During the past financial year, the board of directors of Attendo was composed of four women and four men. Chairman of the Board Ulf Lundahl thinks equal representation of women and men is a good thing, but notes that other factors are also weighed into the board's composition.
"I think we have a good balance of different perspectives, both when it comes to the directors' backgrounds and the perspectives they bring to the work. Discussions are better when we have diversity on the board," says Lundahl.
Chairman of the Nomination Committee Tomas Billing, CEO of Attendo's principal shareholder Nordstjernan, believes the board of directors must have considerable breadth to manage the complex reality that Attendo is faced with.
"Attendo is found in various areas of operations in different countries. That is why it is important that our board includes people of wide-ranging backgrounds and professional experience. There is no question in my mind that being able to unite diversity from various perspectives is a strength," Tomas Billing concludes.
Four out of
five local managers are women.
This section contains a more detailed description of Attendo's sustainability work, our processes and steering mechanisms and examples of initiatives taken and outcomes during the year.
Formal guidelines for how a company's values must be implemented in practice.
Waste that must, according to national law, be managed by an authorised waste management firm.
A structured approach to improving and streamlining the company's environmental work.
Human rights are enshrined in public international law and originate in international agreements. These agreements govern the relationship between the state and individuals and establish that all people, regardless of country, culture and context, are born free and equal in dignity and rights.
Identification of the company's most significant issues from the social, financial and environmental perspectives. The most material issues are those concerning which stakeholders have the highest expectations and those where the business has the greatest impact on others.
Groups of people who are involved in and/or have a financial interest in a business.
Dialogue with stakeholders within and outside the company aimed at identifying the expectations of various groups concerning the business.
Care and health care combined are the largest public expenditure item in all Nordic countries. The sector is extremely important to customers and patients and their families, employees and society as a whole. The public demand is that every individual must be offered the best possible care and health care, with security and quality of life. To make this possible, Attendo focuses on the following:
There is a significant shortage of beds in care for older people in Finland and Sweden. Statistics from the National Board of Housing, Building and Planning (Boverket) show that a full 43 percent of Swedish local authorities had a shortage of nursing home beds in 2017. Statistics compiled by the Swedish Health and Social Care Inspectorate (IVO) show that more than 5,000 older people had to wait more than three months for a bed in a nursing home.
Also according to Boverket, more than 6 out of 10 local authorities have no available beds for people with disabilities. The need for care homes for older people and people with disabilities is also exacerbating the general housing shortage in Sweden.
All indications are that the need for care services is going to continue to grow over the long term. The demographic trend indicates a sharp increase in the population aged 85+ in the Nordic countries in the next 15 years.
In addition to the problems that the shortage of beds in care homes entails for older people and their families, it also generates high costs in other parts of the health care system. The Swedish National Board of Health and Welfare has estimated that older patients who are ready for discharge are remaining
in hospital for about 450,000 days because they cannot be offered a nursing home bed. The conclusion is that there is a crying need to build new care homes for older people and refurbish those that already exist.
The public sector will find it difficult to manage the level of investment required on their own. The new builds that Attendo and other private providers can contribute are thus extremely important to managing the capacity shortage.
Private providers accounted for about half of all new production of nursing homes in Sweden and Finland in recent years. Attendo alone has provided one out of four new nursing home beds.
Investments in new nursing homes also lead to several other positive impacts on society. Every new nursing home with 54 apartments creates about 50 jobs once up and running, as well as more than 30 annual jobs during the building phase. When a new building is built, older nursing homes can often be
had a shortage of nursing home beds in 2017. 0 converted to ordinary housing and thus help alleviate the housing shortage.
New homes also contribute to urban development because care for older people is an important component of a vibrant city district. One example of this is when Attendo issued a letter of intent in 2017 to establish a nursing home in Täby to be co-located with a preschool to facilitate intergenerational encounters.
When Attendo continuously builds new facilities, the company also supports local authorities with expertise in nursing home establishment, from the identification of suitable land to construction, staff recruitment and moving in of residents.
In recent years, Attendo has picked up the pace in establishing nursing homes and care homes for people with disabilities in Sweden and Finland. A new record was set in 2017 when Attendo had 2,903 beds under construction at year-end.
Of all private providers, Attendo has contributed the biggest addition of new beds. The company intends to maintain a high rate of investment in new homes in the next few years.
One of Attendo's primary strengths is its ability to address complex care and health care challenges. Our services include care and health care for individuals with multiple disabilities or especially complex diagnoses, such as Huntington's disease and Parkinson's disease. Within individual and family care, our assistance includes helping local authorities create a good life for unaccompanied refugee children.
A documentation scrapbook has been developed for children and young people in family care homes, which is filled with information and memories from the home, named "My time with the family". The documentation is intended to give these individuals a sense of rootedness, which is often something they lack when they are older. Attendo also provides meaningful activities for people with intellectual disabilities and works actively to match individuals enrolled in our daily activities programmes with workplaces/work experience places where they can come as close as possible to ordinary working life.
With more than 24,000 employees, Attendo is one of the largest employers in the Nordics.
Another ambition is for more group homes to be able to offer accommodation for couples.
In Finland, Attendo is helping to secure access to local care and health care in small and remote communities, which is a vital effort to ensure that everyone receives the care and health care they need. Many local authorities choose Attendo because this partnership helps improve quality of care while making costs to the local authority clear and transparent, which leads to more efficient use of tax funds.
Attendo also contributes to the economy through tax on the company's profits and payroll-related taxes. In 2017, Attendo paid SEK 207 million in corporate tax, including SEK 116 million in Sweden and SEK 87 million in Finland. Attendo pays more tax than any other private care services provider in Sweden and Finland. Attendo always pays tax on the surplus reported for each operation in the country where the profit is generated.
Attendo creates alternatives in care and health care and gives customers and patients the opportunity to choose. With more than 24,000 employees, Attendo is one of the largest employers in the Nordics. This facilitates greater opportunities for career development and more alternatives for employees in care and health care. Attendo also provides an important contribution to the labour market by offering people a gateway to their first jobs, especially for young people and recently arrived migrants.
Attendo is working to establish higher concern for the environment in all operations. Efforts are
ongoing in accordance with the company's environmental policy, which dictates how operations must be run with care and concern for the environment and how employees, partners and suppliers are expected to act. All managers are responsible for ensuring that operations comply with the environmental laws that apply and for taking environmental aspects into consideration with regard to products and services, transport, energy and water use and waste management. Attendo's environmental management system gives all employees access to expertise, procedures and processes to support them in their day-to-day work.
The company's ambition is to continuously develop environmental efforts primarily within:
Environmental aspects are considered in connection with purchasing products and services. For example, Attendo chooses energy-efficient products for new builds and is working actively to quality-assure consumption and reduce energy losses. Efforts with more systematic monitoring of environmental and social issues in relation to our suppliers continued during the year. System support has been introduced to enable systematic measurement and statistical follow-up, and many of Attendo's operations have been working actively with hygiene procedures and skills, which is reducing the use of plastic gloves.
Attendo also takes climate and environmental aspects into consideration with regard to transport, shipments and business travel. Environmental aspects are always considered in decisions concerning vehicles used in operations, and consumption is regularly measured to control environmental impact. Focus was directed at car travel during the year as part of Attendo's efforts to deliver excellent service, where a calm and economical driving style was promoted as superior from both the environmental and traffic safety perspectives. The usage of video conferencing and other technical aids is being increased to reduce travel in connection with meetings. Purchases are also planned from a limited number of suppliers in order to coordinate goods deliveries and thus reduce the number of transports to our operations.
Attendo's quality work goes further than required by law and customers. It gives us the opportunity to offer market-leading quality of care and to drive development in the sector. At Attendo, we are working systematically to continuously improve our quality efforts and we track the outcome of our work on an ongoing basis.
Much of that currently considered generally accepted praxis in the Swedish care sector, such as social documentation, contact persons and "personal time", are the results of Attendo's development work. At Attendo, we are convinced that quality of care and health care can be measured. We are constantly endeavouring to further elevate both technical and perceived quality.
Historically, our efforts have been oriented mainly
towards the measured "technical" quality. We are now increasingly focused on further improving perceived quality: how satisfied our customers and their families are with the service Attendo delivers.
Laws and regulations govern care and health care providers with regard to things such as care and health care services, employee health and safety, information security, infection control, food production and fire prevention. Local authorities are responsible for assuring high quality of care, regardless of whether it is delivered by a private or public provider, and conduct regular quality audits of private provider operations.
We evaluate both individual care and health care delivery and operations overall. Attendo has a quality management system in which processes and activities are defined, measured and followed up every month. The work is led by local quality coaches, who are supported by specialised quality functions.
Our constant endeavour is to develop and improve quality of care.
Best available knowledge: Attendo attaches great importance to knowledge transfer and has strategies and procedures for spreading the best available knowledge and evidence-based practice throughout the organisation. We compare units according to several different parameters to identify and spread optimal work procedures. Attendo has, for example, developed market-leading tools in lifestyle homes and culinary experiences, which are applied across the company.
Systematic improvements: We work in a systematic and carefully prepared manner with every aspect of planning, execution, monitoring and development. Systematic quality improvement must permeate everything we do. It ensures that we comply with laws and regulations and that we always identify and take advantage of opportunities for improvement in operations.
Attendo's own quality index, the "Quality Thermometer" consists of nine components within the three pillars that can be adapted to the various types of operations. The results at the unit, regional and group level give us a comprehensive view of how well quality improvement is working and what needs to be done to further enhance quality. Central quality functions regularly carry out comprehensive internal inspections and audits and provide training and support to local quality coordinators.
The Quality Wheel is our model for systematic quality improvement. The four parts of the wheel – planning, implementation, evaluation and development – contain approaches and methods for the day-to-day work as well as tools for measuring, monitoring and improving our initiatives.
Our quality improvement system is based on careful planning that gives us the time to do extra little things that brighten people's days. The employees' work is planned based on the customers' implementation, health, care and rehabilitation plans, which are descriptions of the services the customer needs and how they should be delivered to meet the individual's needs and wishes.
All plans, procedures and systems in the quality improvement area are aimed at making the encounter with the individual as good as possible. Guidelines in the form of handbooks in the areas of quality, employees, activities and mealtimes provide help and support in the day-to-day work. Planning sheets and checklists are used to ensure that no care services are inadvertently omitted.
Service implementation is also controlled by the operation's development plans, which are prepared based on the results of the annual customer survey, our internal audit or external audits
We monitor quality every month using the Quality Thermometer, which is used to follow up operational quality. The thermometer measures and weighs ten quality parameters.
Regular patient, customer and employee surveys are an important component of quality monitoring.
An effective quality improvement system can always be made even better. Based on the results of surveys, external audits, our own internal audit, etc., we prepare action plans in order to further improve the quality of everything we do. We strive for a culture that encourages continuous quality improvements. One way we do this is to implement and spread our employees' good ideas. Employee skills development is a key component of all quality improvement efforts. The quality department monitors novel approaches, innovations and the latest research and shares the information with the rest of the organisation.
The competence, commitment and care of Attendo employees are critical to ensuring that our customers, patients and their families are satisfied with our efforts. People in various phases of life, of varying nationalities and with unique needs, benefit from Attendo's care and health care every day. That is why a diverse workforce is so important.
Attendo's operations are based on a strong foundation of shared values. Our values – competence, commitment and care – function as signposts in our day-to-day efforts in order to fulfil the shared vision: Empowering the individual.
Providing care to people with various needs for support in daily living is Attendo's business. Our customers can often be in a condition where they have difficulty, due to illness or disability, expressing their wishes or defending their rights. Our customers should always feel safe, secure and independent. We put the individual's needs first and treat everyone with respect and warmth. This includes fully respecting and safeguarding the human rights and freedoms of every customer and every employee.
The work to spread and establish support for the vision and values throughout the organisation continued in 2017. The values project is being implemented with the help of 650 local values coaches combined with corporate introduction programmes and informational materials. Attendo's "values weeks" are one concrete example, which focus on the impact of the values in practice and include activities for employees and customers at participating operations. Values are also a recurring theme at the monthly workplace meetings in Attendo's operations, where both local and central themes may be addressed.
In the autumn of 2017, Attendo focused on sexual harassment and assault within the company, in connection with the #metoo campaign. This included a review of the incidence of various forms of harassment and letters to all managers encouraging them to maintain lively discussions of integrity in
the operation and to always swiftly manage and report suspected violations. The reported number of incidents of sexual harassment is low at Attendo compared to many other workplaces, but every incident is one too many. The majority involve harassment of employees by customers. It is almost four times more common for employees to be subjected to inappropriate conduct by a customer than by a colleague or manager.
Active prevention of corruption and conflicts of interest Attendo is a significant supplier to the public sector and it is therefore imperative that Attendo's employees comply with regulations and otherwise act to reduce the risk of corruption, conflicts of interest or improper business methods. Attendo has drafted a Code of Conduct that contains additional guidelines and support relating to the challenges that can arise in day-to-day interactions with customers, employees, business partners and other stakeholders.
The Code covers business ethics as well as areas including human rights and discrimination, whistleblower protection for employees, employment conditions and health and safety. The rules in the Code include that employees are not allowed to offer or accept any form of gifts, rewards, entertainment or other types of benefits that might affect business relationships or decisions or create dependencies between Attendo and a third party.
All Attendo employees are informed of their obligation to understand and comply with the Code upon initial employment and regularly thereafter. Violations of the Code or other applicable regulations must be reported to the immediate manager and HR and lead either to a warning or dismissal.
Attendo works actively, systematically and preventively to reduce risks and promote employee health and safety.
The Code of Conduct was carefully reviewed in the autumn of 2017. In connection, local managers were encouraged to address and discuss relevant aspects of the Code at local workplace meetings.
Attendo has more than 24,000 employees in Sweden, Finland, Norway and Denmark. We believe it is essential to be an attractive employer and that our employees should be satisfied with their personal work situation as well as with their employer and their immediate managers. That is why we continuously track employee opinion. This is accomplished mainly through annual appraisal interviews and day-to-day dialogue. We augment this frequently by "taking the temperature" of our employees to keep tabs on our employees' job situations and how satisfied they are with their jobs and workplace. The results of these surveys are consistently very good and stable. The average employee satisfaction score in 2017 was 4.0 out of 5.0. Satisfaction with the nearest manager was 3.9 out of 5.0.
Attendo provides training to all employees to ensure high quality and continuous improvement. All employees are provided a thorough introduction, including supervised shifts and a mentor programme. All subsequent skills development is based on individual plans. These may include local, corporate and online training programmes.
The company's and the employee's objectives and how they fit together are discussed during annual appraisal interviews. We also promote continuous learning and encourage job rotation.
Attendo seeks leaders who want to make a
difference and the company works systematically to recruit and develop the best leaders. At Attendo, leadership is all about accountability, visibility and accessibility.
Leaders must communicate clearly and transparently while remaining open to others' ideas. The organisation is flexible and decentralised. Local managers bear substantial personal responsibility for their operations and are expected to systematically delegate responsibility so that employees feel empowered. Attendo is investing in enhancing the skills of local managers, primarily through internal basic training, but also advanced training in various types of procedures, working methods and regulations.
Attendo works actively, systematically and preventively to reduce risks and promote employee health and safety. Managers and employees are trained to assess risks and act in a manner that ensures safe and secure workplaces and prevents the risk of threats and violence. Sickness absences are followed up to help employees return to work as quickly as appropriate. The employee's manager is responsible for getting in touch on the first day of sick leave. Rehabilitation is discussed on an ongoing basis and long-term sickness absences are managed in a structured way.
The implementation of Mobile Care continued in 2017. Mobile Care is a digital app that enhances the quality of care through more secure handovers while reducing stress for our employees. A decision was made jointly with the vendor at the end of the year to begin an introduction of the tool at Attendo's nursing homes as well.
Every Attendo employee must be treated respectfully and given equal opportunities for career development. It is a fundamental precept that everyone should have equitable terms of employment and equal working conditions. Attendo should have proud employees who uphold the principle of the equal dignity of all human beings.
We actively work against all forms of discrimina-
tion. Local managers are encouraged to maintain lively discussion of issues related to discrimination and harassment in connection with employee meetings and to immediately handle or report to HR in cases of suspected violations.
People in various phases of life, with varying nationalities and needs, benefit from Attendo's care and health care every day. For Attendo, the concept of diversity also means that all customers and patients must be provided care by employees who understand their needs. This is why diversity among our employees is important to us, not least in terms of cultural background. Cultural awareness and language skills from other countries are often an advantage in Attendo's operations.
Attendo works continuously to secure access to qualified employees. A project has been ongoing in Finland for several years in which nurses from The Philippines are taught Finnish and offered the opportunity to work for Attendo under contractually agreed conditions. The project has been successful and is appreciated by customers and their families.
There is a severe shortage of nurses in the care and health care sector in Sweden. During 2017, Attendo had a central recruitment unit for marketing, recruitment and skills development for nurses. The most important outcome is that there have been several applications for every available position. A project to recruit Filipina nurses is also ongoing in Sweden. During 2017, about 60 Filipina nurses were hired in Sweden and the company has decided to extend the project until 2019.
Attendo has been offering employees and managers the opportunity to become part owners for a long time. In conjunction with the IPO in 2015, more than 800 employees subscribed for shares in the company, and the following year more than 500 employees joined the Attendo+ share savings programme, which ran until August 2017. A new edition of Attendo+ was launched in September 2017, which was offered to about 60 managers and key employees.
| Potential risk areas | Management of the risk | |
|---|---|---|
| Social conditions and human rights |
Risks include lost contracts, legal san ctions and/or that the Attendo brand is scrutinised or damaged if Attendo fails to provide health and social care without discrimination based on factors including religion, gender and sexual orientation and to provide health and social care that ensures human dignity and meets people's needs, regardless of the situation. |
Attendo complies with applicable collective agreements and pursues active values initiatives through local managers and/or local values coaches in all workplaces, with regular discussions of values among managers and employees. The Attendo Code of Conduct imposes clear demands on employees, partners and suppliers in relation to social conditions and respect for human rights. |
| Employees | Access to competent employees is critical to Attendo's business. The competence, commitment and care of Attendo employees are critical to ensuring that our customers, patients and their families are satisfied with our efforts. If Attendo's employees are unhappy or are no longer committed, there is risk they will resign or go out on sick leave. If the employer brand is damaged, there is also risk that it will be more difficult for Attendo to attract new employees. |
Attendo regularly measures employee job satisfaction, monitors local sickness absence rates and employee turnover and, as needed, assists local managers with action plans. Employees are offered opportunities to build their skills by means including web-based training. Further training to obtain managerial or spe cialist skills is encouraged. Central functions support local recruit ment, with specialists teams oriented towards occupations where there are shortages of qualified prospective employees, such as nurses. Work environment management is pursued systematically to ensure a safe and secure work environment. Analyses and ac tions are regularly discussed at workplace meetings. In addition to regional monitoring, random checks are carried out in which the work environment is audited and managers and employees are interviewed. Action plans are prepared as necessary. |
| Anti-corruption | There are risks associated with tenders as well as procurement of suppliers, in connection with new construction, for example. Potential effects include legal ramifications and negative impact on the brand. |
The Attendo Code of Conduct contains clear guidelines for how employees, partners and suppliers are permitted to act in procu rement situations and in relation to ongoing contracts. Attendo does not accept gifts to/from customers, customers or suppliers. Departures from the Code may lead to warnings and/or contract termination. |
| Environment | Environmental risks are primarily rela ted to the buildings in which Attendo operates and the company's vehicle fleet. According to the Swedish En vironmental Regulation, operators are responsible for any pollution or other environmental damage and for reme diation. There are also risks related to climate change, such as higher risk of floods, collapses, landslides, erosion and heat waves. |
Attendo is working to establish higher concern for the environme nt in all operations. Efforts are ongoing in accordance with the company's environmental policy, which dictates how operations must be run with care and concern for the environment and how employees, partners and suppliers are expected to act. All leaders are responsible for ensuring that operations comply with the environmental laws that apply and take environmental aspects into consideration with regard to products and services, transport, energy and water use and waste management. Attendo's environmental management system gives all employees access to expertise, procedures and processes to support them in their day-to-day work. |
To the general meeting of the shareholders in Attendo AB (publ) corporate identity number 559026-7885
It is the board of directors who is responsible for the statutory sustainability report for the year 2017 and that it has been prepared in accordance with the Annual Accounts Act.
Our examination has been conducted in accordance with FAR's auditing standard RevR 12 The auditor's opinion regarding the statutory sustainability report. This means that our examination of the statutory sustainability report is substantially different and less in scope than an audit conducted
in accordance with International Standards on Auditing and generally accepted auditing standards in Sweden. We believe that the examination has provided us with sufficient basis for our opinion.
A statutory sustainability report has been prepared.
Stockholm, 12 March 2018 PricewaterhouseCoopers AB
Authorised Public Authorised Public Accountant Accountant
Patrik Adolfson Eva Medbrant
Design and production: Narva Illustrations: Annelie Carlström Printing: Planograf, 2018
This report is an English translation of a Swedish original. If there are differences between the Swedish and the English version, the Swedish version will prevail.
Care your way
For individual country information, please visit:
Sweden | www.attendo.se Finland | www.attendo.fi Norway | www.attendo.no Denmark | www.attendo.dk
Attendo | P.O. Box 715, SE-182 17 Danderyd, Sweden | +46 (8) 586 252 00 | www.attendo.com
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