Home Care for elderly Indonesia; a new challenge in community managed healthcare In the community...
-
Upload
vivian-hutton -
Category
Documents
-
view
218 -
download
4
Transcript of Home Care for elderly Indonesia; a new challenge in community managed healthcare In the community...
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 Criterion for quality of life in societyCriterion 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!!!