Home Care for elderly Indonesia; Home Care for elderly Indonesia;

a new challenge in a new challenge in community managed healthcarecommunity managed healthcare

In the communityIn the community

For the communityFor the community

By the communityBy the community

Lenny van Ameijde, M.A.

Master of Arts (social science), Master International Service Management

Director SerVision International:

• healthcare; tourism and hospitality; education

Dissertation Semarang, Undip, Dr. Kariady Hospital

“Empowerment of Indonesian nurses and quality of care, A Patient perspective” (2007)

Presentation byPresentation by

1.1. Considerations home care for the elderlyConsiderations home care for the elderly

2.2. Ageing society IndonesiaAgeing society Indonesia

3.3. Development home care in The NetherlandsDevelopment home care in The Netherlands

4.4. Development home care in IndonesiaDevelopment home care in Indonesia

5.5. Strategy for the futureStrategy for the future

6.6. Competencies home care nurseCompetencies home care nurse

7.7. Commitment EducationCommitment Education

8.8. RecommendationsRecommendations

9.9. Pilot BaliPilot Bali

10.10. Preconditions implementation home carePreconditions implementation home care

Home care for elderly Indonesia: Home care for elderly Indonesia: a new challenge in community managed a new challenge in community managed

healthcarehealthcare

Ageing societyAgeing society Responsibility of society Responsibility of society Criteria for quality of life in societyCriteria for quality of life in society Be active, be pro-activeBe active, be pro-active If no action, the elderly will feel If no action, the elderly will feel

neglected, isolated and lonesome.neglected, isolated and lonesome.

1. Considerations home care elderly1. Considerations home care elderly

The rapidly ageing society:The rapidly ageing society:ARE YOU READY?ARE YOU READY?

Double Ageing

Less young people, so relatively more elderly people

The elderly become older because of better health care

Between 1950 and 2050 the elderly population will quadruple.

2. Ageing Society Indonesia2. Ageing Society Indonesia

Indonesia Population 60+ 80+

2011 230 million 8.5% 0.5%

2050 300 million 25% 4.5%

Source: Undesa, United Nations department for economic and social affairs 2006

Facts & figures IndonesiaFacts & figures Indonesia

More elderly women than elderly menMore elderly women than elderly men

Higher proportion of women is widowHigher proportion of women is widow

Illiteracy rates older women are higherIlliteracy rates older women are higher

Family planning: less children especially among Family planning: less children especially among poor (2.4) poor (2.4)

Migration of young people to the city looking for a Migration of young people to the city looking for a better life while elderly stay in rural areabetter life while elderly stay in rural area

Elderly more dependent on community than on Elderly more dependent on community than on family family

Majority of elderly has low income/status, depends Majority of elderly has low income/status, depends on others (family, government, charities)on others (family, government, charities)

Home care based upon specific Home care based upon specific needs elderlyneeds elderly

Chronic diseases often lead to social problems.

isolationanxiety lonelinessdepression

diabetesbowel problems(incontinence) dementiacancer

Health problemsSocial problems

CARE LADDER The NetherlandsCARE LADDER The Netherlands

Home carevolunteer

Day care

Short stay

Home for elderly

Home careprofessional

Connected senior

apartments

Residence care

compound

In-houseSmall-scale

living

Continuum of careCosts

Level of dependence

Community care Institutional care

Difficulties Homebound Assisted living Bedridden

Nursing home

New concept: self-managing home care New concept: self-managing home care teamsteams

A small decentralized organisation; the central office is just A small decentralized organisation; the central office is just supporting (salary, training, administration) supporting (salary, training, administration)

Client centred, cost effective (30% decrease), custom-made care Client centred, cost effective (30% decrease), custom-made care (client satisfaction 9.1)(client satisfaction 9.1)

Self-steering home care teams of 8-12 nurses/care assistants. Self-steering home care teams of 8-12 nurses/care assistants.

1 Coach for the teams in each district1 Coach for the teams in each district

Few managers, more professionals (low overhead, flexible, Few managers, more professionals (low overhead, flexible, cheap, effective)cheap, effective)

The use of ‘smart’ ICT: home care web and digital communityThe use of ‘smart’ ICT: home care web and digital community

Characteristics Characteristics Self-managing home care Self-managing home care

teamteam

Team of registred S1 and D3 nurses, community nurses level Team of registred S1 and D3 nurses, community nurses level V and care assistants level 3V and care assistants level 3

Team is self-managing, divides tasks among each other, Team is self-managing, divides tasks among each other, makes own planning, asks other nurses to join team if makes own planning, asks other nurses to join team if necessary, so low overhead costs.necessary, so low overhead costs.

24 hours available on-call24 hours available on-call

Elderly clients always are visited by the same nurseElderly clients always are visited by the same nurse

The care is client centred, not task centred, holistic: the nurse The care is client centred, not task centred, holistic: the nurse will do all the care for the client and tries to stimulate will do all the care for the client and tries to stimulate independenceindependence

Tasks self-managing Tasks self-managing home care teamhome care team

Basic care and specialised nursing careBasic care and specialised nursing care

Bathing, hair washing, shaving, grooming, dressingBathing, hair washing, shaving, grooming, dressing

On request of general practitioner or specialist On request of general practitioner or specialist (insulin) injections, take care of wounds, pain (insulin) injections, take care of wounds, pain reductionreduction

Medication prompting Medication prompting

Communicating for client with other caregiversCommunicating for client with other caregivers

Coaching family membersCoaching family members

Dementia care supportDementia care support

Terminal careTerminal care

Network self-managing home care Network self-managing home care teamteam

InterdependentInterdependent

Team works in close cooperation and direct contact Team works in close cooperation and direct contact with general practitioner with general practitioner and and healthcare organisationshealthcare organisations

Transfer nurses from hospitals, general practitioners, Transfer nurses from hospitals, general practitioners, other health care organisations and private people other health care organisations and private people refer elderly to home care team.refer elderly to home care team.

Team gives guidance and is intermediary between Team gives guidance and is intermediary between client and doctor or other healthcare professionals.client and doctor or other healthcare professionals.

Has knowledge of specific communityHas knowledge of specific community

Team stays involved also if the elder needs hospital Team stays involved also if the elder needs hospital carecare

Team has a small office in the communityTeam has a small office in the community

Continuing training Continuing training Self-managing home care teamsSelf-managing home care teams

The central office provides a budget for ongoingThe central office provides a budget for ongoing

training, on request of the home care teamstraining, on request of the home care teams

Individual trainingIndividual training

Team trainingTeam training

4. Developent Home care Indonesia4. Developent Home care Indonesia

Healthy Indonesia 2010 – strategy for national health Healthy Indonesia 2010 – strategy for national health

development:development:

In this document community managed healthcare and In this document community managed healthcare and decentralization are promoted, and should be in operation decentralization are promoted, and should be in operation in 2010.in 2010.

Few initiatives have been taken, such as Pusaka in Few initiatives have been taken, such as Pusaka in Jakarta. Jakarta.

The government policy has not succeeded as a consistent The government policy has not succeeded as a consistent policy, absolutely insufficient to match the needs of the policy, absolutely insufficient to match the needs of the elderly.elderly.

At this moment care for elderly (home care) is again on At this moment care for elderly (home care) is again on the political agenda. the political agenda.

Why community managed home care Why community managed home care IndonesiaIndonesia

Less expensive than institutionalised Less expensive than institutionalised care, more cost effective because it care, more cost effective because it covers more elderly.covers more elderly.

Elderly can stay in their own Elderly can stay in their own community which creates self reliance community which creates self reliance and a sense of solidarity within and a sense of solidarity within communities.communities.

Home care is the right thing to do, Home care is the right thing to do, because elderly are reluctant to leave because elderly are reluctant to leave their homes and relatives feel ashamed their homes and relatives feel ashamed to send their parents to a home for to send their parents to a home for elderly.elderly.

PUSAKA concept IndonesiaPUSAKA concept Indonesia

PuPusat sat SASAntunan ntunan dalam dalam KKeluargeluargA A means ‘Home-based Care means ‘Home-based Care Centre’.Centre’.

Pusaka also means ‘old and respected’.Pusaka also means ‘old and respected’.

Concentrates on the first phase of home care, mainly the Concentrates on the first phase of home care, mainly the social component.social component.

In community, near the people: people go to the pusaka In community, near the people: people go to the pusaka postpost

Support provided by family and volunteers from Support provided by family and volunteers from neighbourhoodneighbourhood

Services consist of activities such as meals, repair and Services consist of activities such as meals, repair and cleanliness of the house and watercleanliness of the house and water

Income generating activities such as courses handicraft, Income generating activities such as courses handicraft, cooking, and small grantscooking, and small grants

Some Pusaka centers also provide basic health care for Some Pusaka centers also provide basic health care for the elderly by establishing a the elderly by establishing a Posyandu Lansia Posyandu Lansia (Health (Health Post for the Elderly)Post for the Elderly)..

5. Strategy for the Future5. Strategy for the Future

All partners in healthcare should take their All partners in healthcare should take their responsibility in developing the profession of home care responsibility in developing the profession of home care nurse nurse

The care process should be aimed at the independence The care process should be aimed at the independence of the elderly and their needs, so they can stay at home of the elderly and their needs, so they can stay at home as long as possible.as long as possible.

The relationship between elderly and home care team The relationship between elderly and home care team must be based on trust must be based on trust

In Indonesia it is recommended that also informal care-In Indonesia it is recommended that also informal care-givers (volunteers/ family/neighbours) are involved.givers (volunteers/ family/neighbours) are involved.

The visiting home care nurse should have a central The visiting home care nurse should have a central position in this process and supports the informal care position in this process and supports the informal care givers.givers.

HomeCare4IndonesiaHomeCare4Indonesia

Needselderly

+ family

Self-managinghome care

team

Other actors in healthcare and social system:PUSAKA, Social worker, Hospital, Posyandu (Lansia), Puskesmas,

Fysiotherapist, Dietist, Psychologist, Pharmacy ….

Coordination Education: AIPNI, STIKES, FON-UI

Qu

alit

y o

f L

ife

Quality of care

Tru

st-b

ased

rel

atio

nsh

ip

Intermediary

(feedback)

Social welfare

Health care

Visits at home mostly by the same care-givers

Home care team knows all about the personal situation of the elderly client, changes in health, is human-centred instead of task-centred

Elderly who trust the care givers will not be afraid or ashamed to express their problems

Well informed care givers are able to give custom-made care and can give appropriate feedback to doctors about the situation

Trust can be considered as the first condition to improve the quality of care and quality of life of the elderly client.

Why trust-based relationshipsWhy trust-based relationships

HOME CARE NURSE

ELDERLY

?

Critical ethical reflection

Analitical and

solution focused

Careful Consultation

and Advice

Openminded

and creative

Compassionate

Dedicated

Res

pect

&pa

rtner

ship

Coaching and

training

Coordination and organisation

Pro-active

Knowledge and insight

Co-operative

Build up a trust-based relationship

Human-centred

Communication & negotiation

Sense of humor

6. Competencies home care nurse6. Competencies home care nurse

decisionmaki

ng

To be ahead of new To be ahead of new developments developments

and and

to be pro-active in to be pro-active in

developing home caredeveloping home care

7. Commitment 7. Commitment educatorseducators

Develop a home care curriculum for qualified self-steering Develop a home care curriculum for qualified self-steering home care nurses of different levels. home care nurses of different levels.

Develop specialised modules elderly home care for existing S1 Develop specialised modules elderly home care for existing S1 and D3 nurses (terminal care, incontinence, diabetes etc)and D3 nurses (terminal care, incontinence, diabetes etc)

Let nurse students work as trainee in the community; Let nurse students work as trainee in the community;

Give special attention in home care curriculum to self-steering Give special attention in home care curriculum to self-steering concepts, dialoguing, coaching and training of informal care concepts, dialoguing, coaching and training of informal care givers (e.g. family, neighbours, volunteers)givers (e.g. family, neighbours, volunteers)

Do applied research to needs elderly Do applied research to needs elderly

Develop new research methods that take into account the Develop new research methods that take into account the specific situation of the elderly people. specific situation of the elderly people.

Start pilots based on feasibility studiesStart pilots based on feasibility studies

8. Recommendations to 8. Recommendations to implement home careimplement home care

Goal

Sustainable home care system, in the community, by the community and for the community

Objectives

To increase availability and quality of home care services with self-managing home care teams based upon model HomeCare4Indonesia

To stimulate community awareness

To develop home care curricula and learning materials

9. Pilot project home care Bali (1)9. Pilot project home care Bali (1)

Project organisation

Initiative and coordination: STIKES-Bali

Inventarisation of existing projects and organisations involved

Selection 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 coach

Cooperation 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 clients

Pilot project home care Bali Pilot project home care Bali (2)(2)

Education & training

Short training courses for nurses and volunteers

Development information and training materials (self-care guidelines)

Budget

Budget 1st year STIKES-Bali; after 1st year local government

Sponsors: medical devices, smart ICT

Evaluation after 1 year

Pilot project home care Bali Pilot project home care Bali (3)(3)

Pro-active

Not bureaucratic

Not expensive (low overhead)

Nearby

Needs-focused

10. Preconditions10. Preconditions

2025: Home alone or…2025: Home alone or…

Thank you for your attentionThank you for your attention

YOU ARE READY!!!YOU ARE READY!!!