NHS European Office

The Danish way to live long and prosper | Rebecca Cullen

older people exercising

Rebecca Cullen takes a look at a Danish care model that's transforming the health and wellbeing of older citizens in southern Denmark.

Prevention is better, and often cheaper, than the cure. This is the basis of the highly successful Life Long Living model in Denmark.

Life Long Living is an award-winning programme of interaction between elderly citizens and their municipality which originated in Fredericia, Denmark. Now enshrined in national law, the success of the model means all Danish municipalities must assess the needs and motivation for 'everyday rehabilitation' for any citizen who requests care and practical assistance.

The Fredericia municipality, in southern Denmark, has approximately 50,000 inhabitants, with elderly citizens making up around 20 per cent of the total population. A quarter are supported by the Life Long Living programme and have personalised citizen plans. 

The programme focuses on improving the quality of life at old age, with everyday rehabilitation and prevention keeping patients out of hospital, rather than using traditional and expensive compensatory care. It is now incorporated into the Danish national budget. 

The model aims to maintain physical, social and cognitive abilities – postponing age-related weakening and dependence. The project is divided into five sub-projects: 

1. Everyday rehabilitation and independent living training, conducted by multidisciplinary teams of home trainers, occupational therapists, nurses and physiotherapists
2. Early detection and prevention of acute illness
3. Follow-up home visits after hospital discharge 
4. Welfare technology
5. Prevention and health promotion for those over 60. Annual preventative home visits to over-75s annually. 

Let me tell you a bit more about the first of these sub-projects. Under the Life Long Living model, each patient, or citizen, has their own ‘citizen plan’ – truly person-centred care that places a focus on the individual’s goals for developing or maintaining their ability to perform everyday tasks. 

The plans are carried out with care providers that have undertaken specialist training in rehabilitation, and under the guidance of the multidisciplinary teams. The plans and care bundle are continuously adjusted as the patient’s abilities and motivations change. 

The characteristic results of the model can also be seen in real-life case studies from the region. For instance, the table below details the assistance required by Mrs Olsen. She is 80 years old, has received care for a long time and is diagnosed with COPD. After starting her individual citizen plan, the care Mrs Olsen now requires is shown below:

Assistance in the traditional system  Assistance in the new system 
290 minutes per week (personal care, shopping and cleaning assistance)
35 minutes per week (cleaning assistance), patient now happier and more self-reliant and able to shop and complete personal care herself
Can’t walk without breathing apparatus
Can now walk short distances without breathing apparatus

The difference in assistance between the traditional and the new system is 255 minutes a week of care. Mrs Olsen is also now more independent and satisfied. Financially, for this individual alone, the difference works out at 221 hours per year, with yearly savings corresponding to approximately €8,500. 

After joining the Life Long Living programme, citizens’ practical and personal care needs reduced considerably – 45.9 per cent of referred patients became completely self-reliant, with a further 38.9 per cent becoming partly self-reliant. 

The number of requested services and total cost has decreased by around €2 million per annum. Reducing the total costs allows the municipality to provide more welfare for the growing elderly population but for the same amount of money. 

Along with both finance and quality adding up, the Fredericia programme defines its greatest benefits in terms of patient and staff satisfaction. Satisfied citizens feel a higher degree of self-efficacy, expressing pride and improved quality of life by regaining their independence. 

Employees have reported significantly greater job satisfaction and commitment when working with the new, empowering model. 

Leaders from Fredericia found that certain factors were key for success. These included a strong political agreement on the vision and communicating the vision to staff and citizens on many levels – using resources such as television and newspapers. 

They describe it as a ‘cultural change that makes sense for everybody’ and all stakeholders are actively involved and represented at committees. 

Rebecca Cullen for the NHS European Office, part of the NHS Confederation. Follow her and the European Office on Twitter @RebsCullen @NHSConfed_EU

Discover more

Gain further insight into the Life Long Living model at a free webinar on 8 December, part of the NHS European Office's popular European Models of Care Programme.

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