the potential of ict in supporting domiciliary care – the carer perspective. the case of germany...
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The Potential of ICT in Supporting Domiciliary Care –
The Carer Perspective.
The case of Germany
Heidrun Mollenkopf, Ursula Kloé, Elke Olbermann & Guido Klumpp
Brussels, January 19th, 2010
Workshop "Long-term care challenges in an ageing society: the role of ICT and migrants "
Dr. Guido Klumpp
Executive Director of the German National Association of Senior Citizens’ Organisations (BAGSO)
Ursula Lenz Press officer (connections with member organisations)
Dagmar Kratz Chief accountant (administrative and financial organisation)
The German Team
Dr. Heidrun MollenkopfSociologist and gerontologist. Member of the BAGSO Expert Council.Former Senior researcher at the German Centre for Research on Ageingat the University of Heidelberg.
Ursula KloéSocial Researcher / Market Researcher /Consultant on behalf of industry and market research institutes. Self employed.
Dr. Elke OlbermannPhD in Sociology, Senior Researcher at the Institute of Gerontology, Technical University of Dortmund
The Potential of ICT in Supporting Domiciliary Care
The context of ageing and care in Germany
ICT initiatives: interesting cases (Service Provider / Senior Centre)
ICT in domiciliary care
Research and policy implications
Overview:
In order to elaborate the study, we used a
multi-methods approach
• Desk research (scientific literature, policy reports, projects, media, web sources)
• Investigations based on questionnaires (mail expert interviews) with persons involved in the organisation of domiciliary and institutional care;
• In-depth (personal or phone) interviews with outpatient care service providers and professional care workers (with and without migration background)
• In depth (phone) interviews with persons working in R & D projects addressing ICT in care.
Approach, Tools and Sources
• In-depth personal interviews (case studies) with informal caregivers(with and without migration background)
(1) The Context of Ageing and Care in Germany
Table 1. People in need of care 2007 (number, settings and level of care)
2.25 million people in need of care in 2007
Care in domiciliary settings1.54 million people (68%)
Institutional care709.000 people (32%)
exclusively through family members
1.03 million people
through professional nursing care services
504.000 people
according to Grade of dependencyGrade I: 61.8%Grade II: 29.9%Grade III: 8.3%
according to Grade of dependencyGrade I: 52.5%Grade II: 35.4%Grade III: 12.1%
according to Grade of dependencyGrade I: 35.7%Grade II: 42.3%Grade III: 20.5%without classification 1.5%
accomplished throughinformal care (family, social
network, legal as well as 'grey' market)
accomplished through11.500 outpatient nursing
care services with236.000 employees
in 11.000 nursing homeswith
574.000 employees
Source: Pflegestatistik 2007. Pflege im Rahmen der Pflegeversicherung. Deutschlandergebnisse. Statistisches Bundesamt Wiesbaden, 2008.
• 68% of the people in need of care are getting care at home• Outpatient care in Germany is largely provided by private and
non-profit organisations (98%)• Most care personnel is female and working part-time
The German Social Long-term Care System
Main characteristics– Organisational and financial segregation of Health care and Long-term care
The German Health Care / Social Long-term Care System is characterized by fragmentation & lack of integration and transparency.
LTC:– Benefits dependent on 3 grades of dependency – Legal separation of formal and informal caregiving– Separation of medical treatment and care assistance/home help – Benefits in kind or in cash for self-organized support– Nursing aids and technical aids– Support of family caregivers
(Professional domestic care in the absence of caregivers, unpaid leave)
(2) The Contribution of ICT in Domiciliary Care
ICT initiatives: interesting cases
'Viertes Viertel' Senior Centre Güstrow
'SOPHIA' Service Provider
Interesting cases (1): Senior Centre Güstrow 'Viertes Viertel'
Foto source: Bundesministerium für Familie, Senioren, Frauenund Jugend (BMFSFJ) (2008). Das intelligente Heim. Ablaufoptimierung, kurze Wege, Entbürokratisierung. Bericht über das Modellprogramm. Berlin: BMFSFJ, page 54ff
Although an institution, there are interesting starting-points for future developments to support domiciliary care:
• Leading idea: 'living together' like at home. – Single rooms / high flexibility with furniture to create a feeling of being at home– In every house unit: 11 inhabitants + 4 'care assistants present' (Pflegepräsenzkräfte)– Care workers for persons in need of health care
• Innovative technology to support independence and safe everyday life– Household appliances, e.g., induction cookers and steam ovens – Intercom system with several call- and question/answer-possibilities– access control, smoke/fire detector) in private homes with link to the service office.
Interesting cases (1): Senior Centre Güstrow 'Viertes Viertel'
• Positive experiences if older persons are guided and trained.
Foto source: www.sohia-nrw.de
Phone or
TV
Personalcontact
TV
SOPHIA is a Franchise System, growing all over Germany
Interesting cases (2): Service Provider SOPHIA
• Availability: 24 hours a day, 7 days a week• Covering a wide range of needs
– Organisation of outpatient care or craftsmen / Mediation of supporters / suppliers• Personal 'godfather' for every participant
(based on voluntary work – some of them with migrant background)– Calls at least once a week to chat and to check necessary tasks to be done
• Use of telephone + TV as well as innovative ICT– TV / PC for video communication to connect people with the outside world– Safety devices like emergency bracelet/watch / alarm system / smoke / fire / water
detector.
Service system for persons who want to stay at home
6 Packages: Basis – Safety – Home security – Comfort – Family
Interesting cases (2): Service Provider SOPHIA
(Costs between 21 € and 50 € per month)
• Despite diverging openness: Users show overall satisfaction.
In the beginning, older people show distance towards innovativetechnology, but ---
--- older people are happy to use technologies
– if technologies address their needs– if technologies are accompanied with social attention and support– if the older people receive the necessary training.
Interesting cases (1 + 2): Main findings
• Technology has the potential to support home care in favour of all persons concerned.
First attention and contact mostly through (younger) relatives ---
--- Family carers are relieved of parts of their burden.
(3) ICT in Domiciliary Care: Consultation of Experts
High interest in innovative ICT especially for organisation and documentation (mobile units with connection to central unit)
Advantages: Fast communication, saves time, permanent availability, reduces bureaucracy, releases time for care
Consequence: Centralization of kowledge.
General use of Internet for information about care / health problems / legislation / professional issues etc.
Experts' (care workers') interest and use of ICT
Barriers
Older people
• Low readiness to inform oneself before being in need of support / care• No knowledge about possibilities and costs / funding possibilities• Fear of being dependent on or not being able to use technical device• Use of technology is seen as acknowledgement of needing support
• Lack of information / time / money for selection and installation• Limited opportunities for information, counselling, training• Lack of adequate training material (e.g., in mother tongue)• High fluctuation of empoyees• Lack of interest and lack of acceptance of ICT
Experts' Comments: Barriers
Care Services
Consequences • Difficulties to train employees adequately
• Difficulties in using appropriate ICT
• High concentration on human services
• Innovative ICT has to go on from what people already use or know.
Barriers
Family caregivers as well as outpatient care providers consider the tasks that migrant care workers perform in home care essential for the well-being of the people in need of care.
ICT in Domiciliary Care: Informal Caregivers.
• High legal insecurity • Reduced social rights • Great variety of tasks • Irregular working hours • Little leisure time • Limited social networks.
High regard of tasks performed in home care
General situation of carers with migrant backgrounds
Informal Caregivers. Overview (1)
Sociodemo-graphy
Education
Residence in Germany
Woman from ...
Care career / status
Romania Poland (1) Poland (2) Poland (3) Germany (Turkish Origin)
Germany
55 years Married
28 years Married
32 years Single
25 years Single
28 years Married
42 years Married 2 children
Univ. entr. qualification
Training as technician/ designer
Univ. entr. qualification
Since 2006 training as nurse
Secondary school
Grammar school/ training incompl.
Secondary school
Hairdresser
University training
Nursery teacher
Social educ. worker
Univ. entr. qualification
Training as bank clerk
Since 2005 Since 2002 Since 2000 Since 2002 Since birth Nat. German Since 2005
4 care households
2005–2006: illegally employed
Since 2007: legally empl.
Now: looking for new job
2002/ 2003: Woman of advanced age
Illegally employed
Since 2000: 3 care house-holds
2000-2007 illegally empl.
Since 2008 legally empl. in care center (care assist.)
Since 2002 3 care house-holds (of Polish origin)
2002-2007: illegally employed
Since 2008 legally empl. domestic help (ZAV)
Since 2007 mother in law
Care together with brothers / sisters (in law)
Since 2006 for father, since 2007 both parents
Housekeeping / care in coop. with outp. care serv.
6 km dist. own home parents
Informal Caregivers. Overview (2)
ICT in care households/ private use
Requests / ideas for ICT
Woman from ... Romania Poland (1) Poland (2) Poland (3) Germany (Turkish Origin)
Germany
ICT for communication with relatives of person in need of care Restriction to technical devices availabe in household of person in
need of care
Focus: competences and barriers towards ICT of person in need of care
Telephone One case:
PC/Internet access
Now: tele-phone, mobile, Internet/e-mail of her own
Telephone Babyphone Mobile
(prepaid) for calls to Poland
Telephone, mobile for emergency calls, Inter-net access
Telephone, babyphone
Private calls must be paid
Telephone Mobile
phone for private use
Mother: mobile (big keys, program-med; attached to key ring)
Family(several
times / day): telephone chain, e-mail, sms
Telephone Parents re-
ject mobile Daughter:
internet for information e-mail (outp. care service)
ICT offers in native language Internet access (e-mail) / phone to stay in touch with family at home
Focus: easy access for person in need of care
Online information about o care/health problems o behaviour in emergency
Nothing specific
GPS Easy to use mobile
Online com-munication (e.g. doctor)
E-learning (German language, care)
o cultural peculiari-ties
Summary: Informal Caregivers' Requests / ideas for ICT
• ICT for communication (via internet) and coordination of tasks (with doctor, care workers, relatives of person to be cared for);• Internet access for information about care / health problems / behaviour in case of emergency / cultural peculiarities.• e-learning: German language, issues related to domiciliary care (Condition: training and communication possible in mother tongue).
• Easy to use mobile phone for older persons• GPS system for persons with dementia
Informal caregivers: General trends• High level of education• Trend to legalisation and professionalisation
Requests and wishes for ICT:
Family carers are more concerned about offering suitable ICT solutions to care recipients while (migrant) care assistants are more concerned about improving quality of their work.
Equipment with more modern ICT depends very much on the interests, openness and competences of the principal actors.
Innovative ICT has to go on from what services already use / employees know / older people are acquainted with.
(4) Conclusions: Requests for ICT Development & Training
Conclusions & recommendations (1)
Education / vocational training should integrate the use of innovative ICT
• Time and opportunities for learning has to be provided • Concrete (mother tongue) information in the Internet about home care and potential technical support is needed • Adequate multi-lingual training material has to be developed.
Raise general awareness, de-taboo the issues of care, illness & dementia
• Information campaigns in television and internet.
Education
General
Awareness
Create more transparency / overcome the fragmentation of responsibilities related to
Conclusions & recommendations (2)
Improve technologies and systems• Overcome barriers arising from unsuited design• Avoid stigmatising technologies•. Develop ICT and technical applications that are independent of language.
Conclusions: Requests for ICT Development & Policy Actions
• Health care & Long-term care system / legal regulations • Reimbursement possibilities and conditions.
Create a centralised / systematic/ multilingual online platform• addressing all of these issues + providing information about available technologies / services / possibilities of support.
Legalise the societally important work of caregivers from migrant backgrounds.
System
ICT
Organisation
Legalisation
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