Helge Garåsen The Trondheim Model - NSDM

1.0 Introduction
1.1 Are older patients treated properly?
During spring 2001 several older patients in medical departments at St. Olavs University
Hospital were defined to be long-term nursing home patients. However, they had to remain in
the general hospital for several weeks waiting for beds to become available at nursing homes.
Some of these patients were transferred to empty beds in the heart clinic at St. Elisabeth’s
Hospital, and, according to anecdotes from the nurse coordinating the use of nursing homes’
beds in Trondheim, after a while many of these patients improved their functional status
(ADL) and were therefore able to return to their own homes.
At the same time the municipality established a “transit- nursing- home” where patients could
stay while they were waiting for long-term nursing home beds instead of remaining staying at
the general hospital. Annual reports surrendered by the manager of this department described
that as many as 20 % of these patients could return to their homes after spending a number of
weeks at the “transit-nursing home”.
These stories about older patients defined as nursing-home-patients improving their functional
status and returning home after spending time in stimulating surroundings, made me, as Chief
Medical Officer, and my leader, the Chief Executive Officer, wonder if there might be a
missing link in the chain of care; i.e. something was possibly missing in “the chain of care”
between the general hospital and community care.
1.2 Older people and medical care
Western societies are spending an increasing share of national budgets on health care
consumption (1). In many of these societies health and social care services are under severe
financial pressure and hospital beds are being closed and staff is being shed, this is indeed the
case in the UK and Norway (2-3).
In the coming decades there will be an increasing number of older people in all Western
societies (1,4), in particular there will be a large increase in the number of those above 90
years of age by 2020, and by 2025 there will also be a rather dramatic increase in the number
of people above 80 years of age (1,4). People are living longer, and most of the elderly
persons are functioning better and better in their daily activities. Nevertheless, the proportion
of hospital beds being occupied by older patients in all Western European countries is
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