Presentation on theme: "In the community For the community By the community"— Presentation transcript:
1In the community For the community By the community Home Care for elderly Indonesia; a new challenge in community managed healthcareIn the communityFor the communityBy the communityAttention: I speak about managed, most of the time people say community based, but I prefer managed, used by government and meaning you are active.In, for, by the communityBuying a house: location location locationServices: people, people, people
2Presentation by Lenny van Ameijde, M.A. Master of Arts (social science), Master International Service ManagementDirector SerVision International:healthcare; tourism and hospitality; educationDissertation Semarang, Undip, Dr. Kariady Hospital“Empowerment of Indonesian nurses and quality of care, A Patient perspective” (2007)Earlier experience in Indonesie with UI, project specialised nurses and Univ Diponegoro, I don’t know if there are nurses from Dr. Kariady Hospital Semarang here, a nice stay, people were very much research minded.
3Home care for elderly Indonesia: a new challenge in community managed healthcareConsiderations home care for the elderlyAgeing society IndonesiaDevelopment home care in The NetherlandsDevelopment home care in IndonesiaStrategy for the futureCompetencies home care nurseCommitment EducationRecommendationsPilot BaliPreconditions implementation home careThis is the line of my presentation, I will discuss different aspects of home care.
41. Considerations home care elderly Ageing societyResponsibility of societyCriterion for quality of life in societyBe active, be pro-activeIf no action, the elderly will feel neglected, isolated and lonesome.If we do not take care for the elderly in the last phase of their life, it means we have no respect for life.If you just wait and see, it is too late, if you are pro-active, you are prepared for the ageing society, and there will be not such a gap between needs of elderly and service provided
5The rapidly ageing society: ARE YOU READY? We are on the edge of the rapidly ageing society and the question we have to answer: are we ready
62. Ageing Society Indonesia Double AgeingLess young people, so relatively more elderly peopleThe elderly become older because of better health careBetween 1950 and 2050 the elderly population will quadruple.IndonesiaPopulation60+80+2011230 million8.5%0.5%2050300 million25%4.5%Density 114 people per square km8,5 % = 20 million25%= 75 million80+ from more than 1 million to around 15 million, which is almost the entire population of The NetherlandsSource: Undesa, United Nations department for economic and social affairs 2006
7Facts & figures Indonesia More elderly women than elderly menHigher proportion of women is widowIlliteracy rates older women are higherFamily planning: less children especially among poor (2.4)Migration of young people to the city looking for a better life while elderly stay in rural areaElderly more dependent on community than on familyMajority of elderly has low income/status, depends on others (family, government, charities)Just in a nutshell
8Home care based upon specific needs elderly Chronic diseases often lead to social problems.isolationanxietylonelinessdepressiondiabetesbowel problems(incontinence) dementiacancerHealth problemsSocial problemsHome care consists of a social and a health component. In practice these two components are linked with each other.The older the elderly population gets, the more chance of one or more chronic diseases. In case of more chronic diseases the care becomes complex.
9CARE LADDER The Netherlands Home carevolunteerDay careShort stayHome for elderlyprofessionalConnected senior apartmentsResidence care compoundIn-houseSmall-scalelivingContinuum of careCostsLevel of dependenceCommunity careInstitutional careDifficulties Homebound Assisted living BedriddenNursing homeFirst an overview of the continuum of care, illustrated as a ladder.You will see, as the level of dependence rises, also the costs rise.Small scale living people with dementia, sickness of Alzheimer, small living units attached to a central hall, as close as possible to a homely situationHomely interior design has positive influence on people
10New concept: self-managing home care teams A small decentralized organisation; the central office is just supporting (salary, training, administration)Client centred, cost effective (30% decrease), custom-made care (client satisfaction 9.1)Self-steering home care teams of 8-12 nurses/care assistants.1 Coach for the teams in each districtFew managers, more professionals (low overhead, flexible, cheap, effective)The use of ‘smart’ ICT: home care web and digital communityWhy do I use the word client centred instead of patient centred? Because the use of the word implies that the elderly is treated with respect, as a client who can expect the best care possible, adapted to his or her situation and wishes. A patient is more dependent, has to be ‘patient’…
11Self-managing home care team CharacteristicsSelf-managing home care teamTeam of registred S1 and D3 nurses, community nurses level V and care assistants level 3Team is self-managing, divides tasks among each other, makes own planning, asks other nurses to join team if necessary, so low overhead costs.24 hours available on-callElderly clients always are visited by the same nurseThe care is client centred, not task centred, holistic: the nurse will do all the care for the client and tries to stimulate independence
12Tasks self-managing home care team Basic care and specialised nursing careBathing, hair washing, shaving, grooming, dressingOn request of general practitioner or specialist (insulin) injections, take care of wounds, pain reductionMedication promptingCommunicating for client with other caregiversCoaching family membersDementia care supportTerminal care
13Network self-managing home care team InterdependentTeam works in close cooperation and direct contact with general practitioner and healthcare organisationsTransfer nurses from hospitals, general practitioners, other health care organisations and private people refer elderly to home care team.Team gives guidance and is intermediary between client and doctor or other healthcare professionals.Has knowledge of specific communityTeam stays involved also if the elder needs hospital careTeam has a small office in the community
14Self-managing home care teams Continuing trainingSelf-managing home care teamsThe central office provides a budget for ongoingtraining, on request of the home care teamsIndividual trainingTeam trainingThe training can be in cooperation with a hospital about how to handle new equipment or provided in the skills lab of the nursing schools, or even provided by another home care team
154. Developent Home care Indonesia Healthy Indonesia 2010 – strategy for national healthdevelopment:In this document community managed healthcare and decentralization are promoted, and should be in operation inFew initiatives have been taken, such as Pusaka in Jakarta.The government policy has not succeeded as a consistent policy, absolutely insufficient to match the needs of the elderly.At this moment care for elderly (home care) is again on the political agenda.
16Why community managed home care Indonesia Less expensive than institutionalised care, more cost effective because it covers more elderly.Elderly can stay in their own community which creates self reliance and a sense of solidarity within communities.Home care is the right thing to do, because elderly are reluctant to leave their homes and relatives feel ashamed to send their parents to a home for elderly.
17PUSAKA concept Indonesia Pusat SAntunan dalam KeluargA means ‘Home-based Care Centre’.Pusaka also means ‘old and respected’.Concentrates on the first phase of home care, mainly the social component.In community, near the people: people go to the pusaka postSupport provided by family and volunteers from neighbourhoodServices consist of activities such as meals, repair and cleanliness of the house and waterIncome generating activities such as courses handicraft, cooking, and small grantsSome Pusaka centers also provide basic health care for the elderly by establishing a Posyandu Lansia (Health Post for the Elderly).One of the few initiatives of home care. This is a good initiative for the first phase as shown in the care ladder. But what if health is no longer good, then elderly move to the second phase and need professional health care.
185. Strategy for the Future All partners in healthcare should take their responsibility in developing the profession of home care nurseThe care process should be aimed at the independence of the elderly and their needs, so they can stay at home as long as possible.The relationship between elderly and home care team must be based on trustIn Indonesia it is recommended that also informal care-givers (volunteers/ family/neighbours) are involved.The visiting home care nurse should have a central position in this process and supports the informal care givers.Home care nurse as a spider in the web
19HomeCare4Indonesia Coordination Education: AIPNI, STIKES, FON-UI Needselderly+familySelf-managinghome careteamSocial welfareTrust-based relationshipQuality of LifeHealth careIntermediary(feedback)A home care system with trust-based relationships, a good quality of care, will improve the quality of life.Based upon the needs of the elderly and their family, social welfare and health care.Health-care is provided by independent home care teams, that cooperate closely with other organisations in health care and social careInitiators from education in this system are AIPNI, STIKES and FON-UIOther actors in healthcare and social system:PUSAKA, Social worker, Hospital, Posyandu (Lansia), Puskesmas,Fysiotherapist, Dietist, Psychologist, Pharmacy ….Quality of care
20Why trust-based relationships Visits at home mostly by the same care-giversHome care team knows all about the personal situation of the elderly client, changes in health, is human-centred instead of task-centredElderly who trust the care givers will not be afraid or ashamed to express their problemsWell informed care givers are able to give custom-made care and can give appropriate feedback to doctors about the situationTrust can be considered as the first condition to improve the quality of care and quality of life of the elderly client.
21HOME CARE NURSE ELDERLY ?East and west, different nurses, different levels, specialised nurses and now also home care nurse
226. Competencies home care nurse Careful Consultation and AdviceCommunication & negotiationBuild up a trust-based relationshipOpenminded and creativeCritical ethical reflectionSense of humorCoordination and organisationAnalitical and solution focusedHuman-centredThis is a palette of competencies, linked to each other, important in all education & training of home care nurses. You can consider this as some kind of compass to improve your service during your whole professional life.Developing competencies of home-care nurses needed for client-centred care,Communication skills and negotiation skills: dialoguing is important: Nurses demonstrating ‘dialoguing’ are aware of competing responsibilities and take responsibility together with the client. Client-centred care means commitment with the Client demand, knowing what they want, concerns a process of actively signalling, discussing and negotiating with the client, and actively searching for compromises, or creative solutions, sometimes at organizational level (avocate for patients). Nurses reported having to be very patient sometimes. Dialoguing includes giving and grounding a professional opinion, even if the client did not agree, and respecting the client’s point of view. Professional and personal boundaries are made clear.Respect and partnership, careful consultation and advice: support client participation (negotiate, coach, trust based, humor). It helps when they trust you, clients will not be ashamed to tell you their anxieties, and you will be able to help them betterHandle situations of tensions and dilemmas,( solution focused, openness, creativity).Critical ethical reflection means that sometimes wondering if what you do or did is the most effective, or are there better or new ways? Can you improve yourself?Ethical issues in health care particularly affect the elderly for several reasons: older people are sick more often than younger people, suffer more from being in the end stage of various chronic progressive degenerative diseases and are most likely to lack the capacity to make critical decisions when such decisions have to be made. Clients with the capacity to make health care decisions should have the right to make decisions about their own bodies, based upon good access to information.Analytical: sometimes there are underlying causes for a problem. Not problem solving, but solution focused which is a different approach (knowledge & insight, human centred, creative)Human-centred, not task centred. Sometimes some understanding and compassion is valued more than washing and grooming. You can do both at the same time.Be pro-active, if you see that a patient is sitting all day, and barely walks, may be pressure wounds will be the result. Do something about it before that happens.decisionmakingCompassionateKnowledge and insightDedicatedPro-activeCoaching and trainingCo-operativeRespect &partnership
23To be ahead of new developments 7. Commitment educatorsTo be ahead of new developmentsandto be pro-active indeveloping home careAnticipate new developments, don’t wait till a gap arises
248. Recommendations to implement home care Develop a home care curriculum for qualified self-steering home care nurses of different levels.Develop specialised modules elderly home care for existing S1 and D3 nurses (terminal care, incontinence, diabetes etc)Let nurse students work as trainee in the community;Give special attention in home care curriculum to self-steering concepts, dialoguing, coaching and training of informal care givers (e.g. family, neighbours, volunteers)Do applied research to needs elderlyDevelop new research methods that take into account the specific situation of the elderly people.Start pilots based on feasibility studiesAnticipate new developments, don’t wait till a gap arises24
259. Pilot project home care Bali (1) GoalSustainable home care system, in the community, by the community and for the communityObjectivesTo increase availability and quality of home care services with self-managing home care teams based upon model HomeCare4IndonesiaTo stimulate community awarenessTo develop home care curricula and learning materials
26Pilot project home care Bali (2) Project organisationInitiative and coordination: STIKES-BaliInventarisation of existing projects and organisations involvedSelection of community for pilot (desa Pererenan, this village is selected because it has many elderly people and family that moved to the city)Field assessment (needs elderly, what kind of services)Self-managing home care team and coachCooperation of home care team with other care providers (GP, hospital, health centers Puskesmas and Posyandu) and volunteer organisations (PKK, YKI)Think-tank: criteria, evaluation, research & development home care with representatives from education, hospital doctors/GP’s, nurses and elderly clientsYayasan Kanker IndonesiaPKK welfare organisation
27Pilot project home care Bali (3) Education & trainingShort training courses for nurses and volunteersDevelopment information and training materials (self-care guidelines)BudgetBudget 1st year STIKES-Bali; after 1st year local governmentSponsors: medical devices, smart ICTEvaluation after 1 year
2810. Preconditions Pro-active Not bureaucratic Not expensive (low overhead)NearbyNeeds-focusedEducation and training suited to needs elderly clients
29Thank you for your attention 2025: Home alone or…YOU ARE READY!!!Home alone movy: you should not leave your children alone at home, because terrible things happen, the same goes for the elderly, if we leave them alone, the most terrible things will happen.Thank you for your attention