Background

People living with dementia are more vulnerable, which increases the risk of harm during a missing episode. Although national guidelines exist for dementia care there are no specific standards for preventing, managing, or following up on missing episodes among people living with dementia in care settings. This study aimed to describe and analyse current local documents and checklists used in elderly care and home care services in Swedish municipalities, focusing on prevention and preparedness for missing episodes, and to identify key areas for improvement.

Methods

A multiple document case study was conducted using materials from one county council and eight municipalities, including care homes and home care services, examining instructions, checklists, and routines for situations where a person living with dementia is at risk of going missing or has gone missing, one or several times.

Results

Findings revealed substantial gaps in all participants documents, particularly regarding the updates of the documents, lack of preventive measures except technical solutions, delays of police notification due to inadequate instructions in case of a missing incident, limited understanding of risks and of police procedures as well as insufficient collaboration, Moreover, the decision to contact the police could be delayed for several hours and, in some cases, even days. Neither the resident nor their next of kin were actively involved in any preventive activities or risk assessments.

Conclusions

Local guidelines and checklists in Swedish elderly- and home care services demonstrated substantial deficiencies in the prevention and preparedness of missing episodes involving persons living with dementia. Fundamental elements of preparedness were also lacking, including knowledge‑based collaboration with the police. Taken together, the findings suggest that admission to elderly care with exclusive emphasis on voluntariness and freedom does not necessarily increase safety for persons living with dementia. Safety and person‑centred care should be understood as mutually reinforcing rather than competing objectives.

Rapporten redogör för vilka nyttor/vinster och kostnader som är av betydelse för beslut och planering av verksamheten med Civila insatspersoner (CIP) från olika perspektiv samt ger förslag till vilka nyttor och kostnader som ska fokuseras på vid beslut och i vidare forskning.Nytta, vinster och kostnader avser såväl direkta som indirekta, statiska och dynamiska nyttor och kostnader för olika aktörer. Vid beräkning av nytta/vinst eller kostnader är det i första hand standardvinster och kostnader som är meningsfulla att beräkna.CIP:personer, räddningstjänstföreträdare och myndighetsföreträdare ansåg tidsvinst vid insats som en viktig nytta. CIP-företrädare framhöll vidare nyttan av att skapa gemenskap i lokalsamhället och att ha en egen gemenskap i CIP-grupperna, samt nytta med fler typer av uppdrag, exempelvis inom civilberedskap.

Olika genomförande-strategier och organisering av CIP-verksamheten medför olika möjligheter och begränsningar vad gäller finansiering, olika typer av nytta/vinster eller kostnader och verksamhetsrisker. Den nationella samordningen möjliggör mer kraftfulla och uthålliga insatser vid behov och diversifierade resurser som samordnas möjliggör exempelvis att CIP kan bidra i såväl förebyggande som efterarbete efter insatser.

Den här rapporten sammanställer flera års forskning runt civila insatspersoner (CIP) – frivilliga som samarbetar med kommunal räddningstjänst och larmas på exempelvis hjärtstopp, mindre bränder, trafikolyckor och drunkning. Rapporten ska ses som lite av en handbok i att införa CIP – från rekrytering till upprätthållande – vilka är framgångsfaktorerna och hur undviker man fallgroparna? Dessutom jämförs CIP i landsbygdsmiljö och stadsmiljö. Rapporten täcker aspekter av organisation, utbildning, lagstiftning och IT-stöd för utlarmning och koordinering av CIP. En rad behov och förslag på lösningar ges. Dessutom visar den på effekter av CIP såsom kortade responstider och en ökad känsla av trygghet och samhörighet i lokalsamhället.

There is an increased need for organized forms of volunteerism in emergency response but there is little research on how to implement them. We describe the form as interdependent digitalized co-production and contribute with a requirements specification of how local initiatives of collaboration between rescue services and volunteer first responders can expand through national coordination – for use in small emergencies and large-scale crises. Requirements are identified in relation to the individual, organization, society and information technology (ICT) support. Identified organizational and ICT-(inter)related challenges concern unclear mandatorship and brand, double private-state roles of the alarm operator, inability to make use of local knowledge and end-user perspectives in the ICT-development. Connecting this to theoretical contributions, we argue that there is a need to renew existing typologies of digitalized co-production, e.g., integrating perspectives from institutional isomorphisms.

Organisatorisk innovation förknippas sällan med krishantering. Ändå omfattar lärandet från organisering i kriser ofta nya insikter, kunskaper och arbetssätt om det tas till vara. I det här kapitlet diskuteras samverkan i situationer där mycket står på spel. I kris och räddning möts för varandra obekanta organisationer i respons på oväntade och ofta oönskade situationer. Med utgångspunkt i den för sin tid största sökinsatsen i Sverige efter ett försvunnet barn, identifieras i det följande samverkansformer som fungerar i kris och räddning respektive sådana som inte gör det.

Purpose

The purpose of this paper is to give an account for preparative collaboration between the police and municipal eldercare in Sweden concerning missing persons with dementia.

Design/methodology/approach

Design/methodology/approach used was a qualitative case study design, consisting of one focus group with representatives for the participating organisations, followed by directed content analysis.

Findings

The findings showed a lack of current collaboration and reluctance to new collaborative initiatives. However, when focussing on preparative collaboration of coordinated responses to missing incidents, possibilities for improvement could be identified. The improvements concerned updated personnel response checklists, along with suggestions for an elaborate life story document in eldercare, with police access. Finally, better coordination of the return of the found person and a follow up were proposed.

Research limitations/implications

It is suggested that collaboration must be given different meanings and use different approaches adapted to the different phases in a rescue operation. In the preparation and the response phase, the focus should be on coordination of the resources available. In the pre-planning and prevention phases, as well as in evaluation and learning, horizontal collaboration is more suitable. The amount of data in this study is a research limitation which calls for further research.

Practical implications

It is suggested that collaboration must be given different meanings and use different approaches adapted to the different phases in a rescue operation. In the preparation and the response phase, the focus should be on coordination of the resources available. In the pre-planning and prevention phases, as well as in evaluation and learning, horizontal co-operation is more suitable.

Originality/value

The originality/value of this paper can be found in the novelty of missing person research in Sweden, and in practical suggestions for preparative collaboration concerning persons with dementia who go missing. Finally, it can be found in the suggested need for a more dynamic and process-sensitive view of collaboration in SAR or rescue operations.