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Posts Tagged ‘home-care’

During the pandemic, care-homes have been rat-traps for old people. In Canada more than 80% of deaths attributed to Covid-19 have been in care-homes; in places like England or Germany, the ratio was almost 40%. In Spain, the ratio is 68.67% according to estimates published by RTVE. I would say that something must be done.

I have written before about care-homes (see Services and conveniences) and the need for trained carers. But beyond that, what is needed is a complete overhaul of the way we care for old people. In most countries the system pivots on care-homes instead of caring at home.

Very few people argue that staying at home is the preferred choice of old people. It gives autonomy and independence, as well as familiar surroundings. Those characteristics are invaluable comforts as age advances. And not only that: according to a study, in Alabama those receiving care at home saved the State $4,500 a year, compared with those in care-homes.

As I see it, the only barrier to change the system is the system itself. Care at home implies a complete disruption of the care system logistics. It is easier to hire and control a care person in an institution. In the institution, the system can control comings and goings as well as productivity through close supervision. When you have people going from house to house, you have to give the person autonomy and trust that the work will be well done.

It is easy to see that the professional doing one institutionalized job, and the one doing the home care job have to have quite different training. They do basically the same work, namely helping with basic daily activities, so the difference is not in the acts to be performed. The basic difference is in trust, and trust comes with professionalism to be learned through proper training of attitudes more than aptitudes, even if the latter are also important. Unfortunately, I think the system is not ready for training real care professionals when it is relying on mostly immigrants, untrained and underpaid, who do the best they can with very little preparation.

Note: all the figures cited are taken from The Economist July 25th 2020 “The pandemic shows the urgency of reforming care for the elderly«

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If the number of projects focusing on eHealth is any indication, the market must be huge. The recently published brochure “Research and Innovation in the field of ICT for Health and Wellbeing: an overview” lists 97 on-going or recently finished projects funded by the European Commission. By this measure eHealth apps should now be treated as an uncountable.

It has been said too many times that the ageing of the population will put an unmanageable strain on the social and healthcare sectors. It is (almost) public knowledge that only home-care delivery can somehow tackle the coming situation. If you still have any doubts, a recent article in The Economist can, in a nutshell, reassure you about the existence of a growing demand.

In order to respond to the challenge posed by the growing demand, we need to change the way care is delivered. Regarding social care, maybe only some small adjustments will be needed but, for healthcare, a drastic reengineering of the process is necessary.

Assessing the market by simply counting the number of prospective clients is not a valuable marketing approach. We already know that the number of older people living alone at home will increase. The problem is not the number of prospective clients. The problem is twofold: a) how can we reach that population? and b) what business model will bring eHealth into public domain?

The business model has to be ingrained within the care process. Unless distance care can deliver standards similar to face to face care, eHealth will remain the poor relative to traditional healthcare. To attain those standards the redesigning of the care process has to accommodate: a) the idiosyncrasies of the care professionals; b) the legal implications of distance care; and last but not least c) the trust of the care recipient.

Once the care process has been reengineered, then we could focus on designing the business model. For that, the main issue is who pays for what. Because today, most systems link care acts and payment, while home delivery is meant to reduce care acts, switching the burden from the care giver to the care receiver. Again, the alternative funding mode, per-capita payment, is directed to a single organization, while eHealth will switch the burden from healthcare to social-care. So the eHealth business model has to take into account that the healthcare giver is more successful when a) the care receiver does more towards his or her wellbeing, and b) social-care organizations are more active. Summing up, designing a business model that rewards the success of the organization by measuring how it activates other entities (care-recipient and/or social-care) is not easy.

If we successfully solve the business model conundrum, reaching out to our primary customers (care recipients) should be a piece of cake. Anybody will be willing to use a system that reduces the burdensome features of face to face care, e.g. time consumed in transportation and waiting to be seen. Anybody, – and the number of bodies is only increasing -, will grasp the advantages of permanent monitoring, easy access to advice and other advantages that eHealth can deliver. The point is, is eHealth ready to deliver?

Going through a check list of the situation today against the bare needs listed above, the answer is an unqualified NO.

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