Elzbieta Szwalkiewicz

Ashoka Fellow
Fellow od 2003 roku

Elżbieta stworzyła zorientowany na pacjenta, długoterminowy model opieki, który obejmuje potrzebujących opieki i ich rodziny, personel medyczny i instytucje rządowe. W jej dorobku znajdują się systemowe zmiany w usługach opiekuńczych, w tym korzystne zmiany prawne.

This description of Elzbieta Szwalkiewicz's work was prepared when Elzbieta Szwalkiewicz was elected to the Ashoka Fellowship in 2003.


Elzbieta Szwalkiewicz has created a client-centered, long-term care model that involves family, medical personnel and governmental institutions. With a strong portfolio of positive examples, she is influencing public policies and introducing professional and structural legal standards for national care services.

Nowy pomysł

A nurse and lawyer, Elzbieta is shifting Poland's long-term care from inefficient hospital wards to small, private-owned centers in a holistic approach to address the medical, emotional, and social needs of disabled or elderly people and their families. She is opening the market and encouraging competition for long-term care services where government funds are effectively relocated and voluntary insurance and individual fees are introduced. Elzbieta is combining practical experience with strong lobbying instruments to influence public policies in terms of care for long-term, chronically ill, disabled, and elderly people.
Elżbieta is also addressing the gap in medical training that leads to many inefficiencies and substandard care. Her system of educational training for stationary and in-home care is a client-centered system that incorporates actual patient needs, educating both the family and patient. The concept is based on cooperation of patient, family, healthcare institutions, social aid centers, citizen sector organizations, and government. Elżbieta is working to spread her high-quality approach through partnerships with government officials and the country's Ministry of Health. She is also instituting a media campaign to influence social misconceptions surrounding disability and old age.


It is estimated that more than 10 percent of Poland's population have a series of mental and physical disabilities. More than 100,000 people require intensive, long-term care delivered at stationary centers or in their homes. Polish legislation assures care for the chronically ill and disabled and elderly people, but the mindset is to institutionalize them without reviewing options that might be more favorable to the patient. Once institutionalized, patients expect only occasional visits from doctors and nurses, and families struggle with no knowledge of or resources for their loved one who may lie in bed for months or years. Existing organizations do not address all the needs of a patient, focusing instead on one particular side of the problem–medical, emotional, or social.

In addition, Poland's healthcare system is doctor centered and nurses are not encouraged to improve their qualifications or seek additional training. Fewer nurses are entering the workforce compared with previous years, and because most nurses train in an area of specialty, few are able to provide basic patient care.

Because of the progress in medical technologies and development of new medicines coupled with a decrease in funding, patients can expect shortened stays in the public hospital. Few patients can afford private medical treatment. Hence, the need for long-term care in nursing centers or in patients' homes is increasing. However, hospitals and other institutions are not prepared in terms of infrastructure, numbers, and personnel qualification to deliver quality care services at hospitals or patients' homes. This kind of care has been organized only accidentally, without careful coordination, and on an individual basis by different institutions. This is a particular area of concern as Poland and its neighbors expect to see the numbers of elderly people and those with debilitating illnesses rise; now is the time to work out a solution that will meet the anticipated demand in 5 to 10 years.


Through practical experience in hospitals and in the national administration, Elzbietahas identified that only by releasing the government-controlled system of long-term care into the free market of services will the country be able to assure the quality and standards in long-term care. She has promoted integrated healthcare and social aid systems based on professional cooperation with families and different institutions. Introducing a bottom-up approach, Elzbietais cooperating with national institutions, organizations, and companies that influence the market of medical services for disabled and chronically ill people in the country. The monopoly of hospital wards has been broken and opened to competition from private and nonprofit organizations. In 1995 Elzbietaestablished the Association for the Benefit of Ill and Long-term Immobile Blue Umbrella and continued to lobby for her idea to identify strategic partners for establishing a model center for a high-quality, long-term care system.

In 1998 Elzbietabegan preparing a model center for long-term care in Olsztyn. To demonstrate the cost-effectiveness and the implementation of care standards, Elzbietadeveloped the center by incorporating a number of medical services, equipment rental facilities, and other necessary resources. In 2000 more then 400 people, including representatives of medical professions, nurses, nonprofit organizations and Ministry of Health, took part in a conference for the opening of the Care Center "Blue Umbrella" in Olsztyn.

At the base of her plan, Elzbietaimplements a five-level nursing system to address the issue of quality and standards in long-term care. In the first level, she is developing homecare assistants among a patient's family members and is educating family members and patients about basic care after release from a center or hospital. In the second level, she is training social caretakers, mostly those delegated by social aid centers or the Red Cross, and introducing them to standards of long-term care. The third level is a new level of nursing care Elzbietais creating completely from the bottom up; professional medical caretakers will be trained to apply basic medical and rehabilitation procedures, but will also assist in daily routine activities. The fourth level embraces nurses with advanced educations and vocational training, while the fifth level gathers nurses with university degrees to develop learning programs and engage them in the managerial functions of care centers.

In just a few years, Elzbietahas trained several hundred leaders, more then 400 helpers, more then 200 care assistants, and about 200 other medical staff, including physiotherapists and social workers. Beyond direct engagement in designing educational programs, Elzbietahas been positioned as a governmental expert in the area of long-term care. She has intervened in a number of hospital cases where the quality of care has been neglected and has contributed to closing down several hospital wards that did not meet the standard criteria.

To address the issue of the decreasing number of nurses, Elzbietaintroduces training programs for women from rural areas to become homecare assistants (first level of nursing) and provide homecare in their villages. Out of 60 women, 58 are employed. Along with training women and medical personnel, Elzbietaaddresses disabled, ill persons and their families. Educational programs she has designed increase their knowledge and feeling of security and decrease fears toward disease, disability, and old age. Healthy people learn to accept disability and are prepared to face the age of retirement. Elzbietaexpects that every year she will be able to train about 200 people. Since 1996, her association has opened its chapters in 12 cities. With the changes in the legal system the chapters have changed into associations; three of them run independent care centers, applying new criteria and standards for long-term care.To spread the experience and standards for long-term care, Elzbietaaddresses representatives of institutions working with different forms of long-term care. Those programs are aimed at increasing the health and safety of chronically ill people and the disabled. Through seminars, conferences, and exhibitions, she addresses public audiences interested in long-term care in the country and abroad. She has formed a coalition embracing representatives from the Ministry of Health, the parliamentary Commission for Health, and public and citizen sector institutions to reform the area of long-term care. She influences public budgetary policies to ensure availability of funds for education and training on self-care for the disabled and their families. Her coalition is cooperating with insurance companies and Ministry of Finance representatives to introduce voluntary insurance in case of long-term illness or disability that will also be partially supported by public funds.

Because long-term care for disabled, chronically ill, and elderly people rely heavily on public funds, Elzbietapredicts that it will take years to secure and address all the needs of the most needy people. Promotion and lobbying among opinion leaders aim at motivating people to become responsible for their own health. In addition, Elzbietais launching a media campaign to make people aware and prepared for the realities of long-term illness, disability, and old age. In 2001, Elzbietabecame a National Consultant in the field of Nursing Chronically Ill and Disabled People affiliated with the Ministry of Health. Through that voluntary position, she has authored long-term care recommendations that incorporated in public health policies. By spreading this information, she believes that every year, a few new professional centers will be created to address about 200 patients in every administrative region. Elzbietaplans on increasing the number of centers and patients served throughout the coming years.


Elzbieta missed her final exams in high school because of health problems, and rescheduled the tests a few months later with a large group of disabled people. The experience of being around so many people with disabilities caused her to reflect on their situation and problems. In nursing school, Elzbieta was particularly interested in those with long-term disabilities who could control neither their bodies nor their lives. She was always curious to learn what happened to patients after they left the hospital. She found out that most of them would never leave their room or home, unless to return to the hospital. Throughout her work in the hospital, Elzbieta discovered gaps in long-term care and lack of services that need to be provided to long-term disabled people. With professional development, promotion, a wider range of responsibilities, and perspective on her work, she discovered that little could be achieved for improving the quality care without governmental support. To understand the legalities better, Elzbietastudied law from 1986 to 1991 and prepared herself to design and propose legal changes in national health policies. By 1991 she was the only nurse in Poland with a law degree.

In 1991 Elzbietabecame a member of Naczelna Rada Pielęgniarek i Położnych–National Board of Nurses and Midwives–and was instrumental in designing and introducing significant changes in long-term care for disabled and chronically ill people. In 1992, she introduced legal changes regulating the structure and standards for nursing homes. In 1995 Elzbietaintroduced a Nursing Department in the Ministry of Health and has been cooperating with the organization to design standards for stationary and homecare. Her pioneering work introduced standards of care for people with bedsores and standards and criteria for long-term care in Poland. At the same time (1995 - 1998), she worked on establishing the Association of Ill and Long-Term Immobile Blue Umbrella and attracted many in-kind donations, and care and rehabilitation equipment to furnish the center. Elzbietahas already conducted a series of training for nurses and homecare personnel.

By 1998 Elzbietawas ready to take on the system as a whole. While building coalitions and partnerships, she made contacts on all different administration levels, as well as with the unemployment office and farmers' organizations to support unemployment training for rural women. Her approach to prevent negligent care and repetitive stays in hospitals boosts health safety in a humanitarian and cost-effective way. Over the course of her career, Elzbietahas been through four government changes and seven Ministries of Health, but still she has managed to persevere to introduce her new approach in long-term care.