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Holistic views and the integration of long-term care systems needed 

21 May 2013
  • Top 10 priorities for breakthrough include patient-centered care, innovative funding and models, community involvement, societal acceptance.

  • Singapore: crucial to engage all stakeholders, combine medical and social care

As societies age, long-term eldercare must remain affordable. New funding, patient care and programmes must also be devised quickly if long-term eldercare systems are to cope with the inevitable surge in demand.

These are some of the insights from Singapore and other parts of the world on eldercare shared in a new report developed by KPMG and commissioned by the Lien Foundation.
An Uncertain Age: Reimagining Long-term Care in the 21st Century is based on interviews with 46 thought leaders, professionals and practitioners about current and emerging trends, and challenges in the eldercare sector across 14 countries and territories.

Long-term care, said the report’s contributors, languishes among the priorities of national healthcare agendas worldwide. Policy makers and eldercare experts must collaborate in developing new solutions and methods for dismantling societal perceptions of ageing.

The report identifies 10 areas of action to shape a positive future for long-term care:
  1. Deliver person-centered care

  2. Integrate care

  3. Rethink medical care

  4. Look beyond institutional boundaries to the community

  5. Invest in the formal and informal workforce

  6. Embrace technology

  7. Focus on outcomes

  8. Develop better funding models

  9. Carry out more research

  10. Change attitudes to ageing


“Compared with other areas of social and medical policy, long-term care has not received enough attention or investment and this reflects broader attitudes to the elderly around the world,” said Dr Loke Wai Chiong, Director, Global Healthcare Centre of Excellence, KPMG in Singapore.

On the challenges facing eldercare systems today, Lien Foundation’s Chief Executive Officer Mr Lee Poh Wah said: “As governments recognise the urgency for improved eldercare, they grapple with issues on cost, competing priorities and questions of sustainability. The answers lie beyond just enhancing quality of care. There is an overwhelming need for greater and easier access, as well as equity in healthcare systems. Respect for personal choices and control, and transparency in the costs of care are other key factors that could successfully transform care outcomes for the future.”

Current eldercare models too fragmented: more integration needed

Eldercare practitioners and thought leaders interviewed agreed that one of the biggest threats to the future of long-term eldercare is fragmentation. This has resulted in care systems which are focused on systems and procedures of healthcare providers but neglect the patient’s aspirations, dignity and needs.

Societies with rapidly ageing populations urgently need to have societal conversations and build consensus around what long-term care means in their context. Following on, more standards and guidelines for long-term care then need to be developed.

Dr Loke explained: “Long-term care is a hybrid of traditional medicine and social services. Medical care professionals often focus on curing without recognising the emotional or psychological suffering caused by treatment.”

The report notes that integrating care - by better coordinating the different healthcare professionals along the long-term care value chain and enabling higher quality, patient-centred eldercare - is paramount.

Said Baroness Sally Greengross, Commissioner, Equality and Human Rights Commission from the United Kingdom: “Integration is essential and this is currently a real problem. Plans are not coordinated, health and social care are not integrated and housing is not incorporated. There is a need for integrated budgets and services.”

Experts interviewed in the report also feel that governments should consider developing a holistic elderly policy, rather than the current practice of differentiating among welfare, health, housing and social care.

“Effective links with primary care physicians and hospitals should receive major attention throughout the long-term care process. Fully integrated care and successful care recipient outcomes cannot be attained without the means to achieve the sustained involvement of these two important providers,” said Dr Dennis Kodner, International Visiting Fellow, The King’s Fund.

Technology is vital, but so is training

The report notes that better use of technology, as well as improved staff recruitment and training can facilitate better integration. Technology such as remote monitoring systems and sophisticated data analysis can also increase efficiency and improve life for the elderly.

Dr Loke said: “Over time, this approach should mature to offer seamless services by allowing better data sharing and the coordination of multidisciplinary teams, better outcomes and lower costs.”

Staff recruitment and training are also important. He said: “Hospitals and long-term care providers should invest in staff training and support. Providers can also work more closely with carers to develop a plan for every care recipient.”

In addition, the model of care should be determined first, before the choice of technology.

“The problem of technology adoption is really a care model problem, “ said Eric Dishman, Intel Fellow and General Manager of Health Strategy and Solutions, Intel Corporation, United States of America, “Most of the countries that we are looking at start trying to adopt technology, but they haven’t stepped back to firstly identify the care model. Is it a nurse-driven model, physician-driven model, family- driven model? They need to decide on a care model before determining the IT tools required to support that model.”

More creative solutions and funding models needed

According to the Organisation for Economic Cooperation and Development (OECD), public spending on long-term care will double to 2.8 percent of GDP among OECD member countries by 2050.

Against this backdrop, ongoing debates about who pays for the long-term care of the elderly are becoming more important. More innovative, sustainable healthcare funding models are also needed to tackle the longer term issues of demographic change through all economic conditions.

At the same time, governments should encourage their citizens to save more for retirement and take out specific long-term care insurance policies.

Healthcare leaders interviewed also emphasised that active dialogue and research are necessary for the development of innovative solutions to long-term care. For example, governments and providers can consider alternative facilities such as patient hotels being developed in Europe. In a patient hotel, healthcare providers manage treatment while hotel providers are responsible for recovery.

The role of the community can also be expanded by establishing ‘virtual villages’ within existing urban communities. Elderly residents and other volunteers in a neighbourhood can help one another with basic services such as transportation, home maintenance, health and wellness.

Singapore: involve stakeholders, new model of medical and social care proposed

To drive greater transformation in the eldercare sector, stakeholders must be engaged in all aspects - through collaboration, integration, education or innovation – so that all can come together in a concerted manner.

Yeoh Lam Keong, Senior Adjunct Fellow and Vice President, Institute of Policy Studies & Economics Society of Singapore, noted in the report: “In social eldercare and also in end-of-life care in particular, there are many grey areas where a social consensus needs to be reached on what is ‘acceptable care’. The government has a big role to play in forging consensus. This is the role of leadership.”

Lessons from the report can be helpful in the goal of consensus building for Singapore.

These include:
  • Encouraging stakeholders in healthcare and social services to collaborate in the development of new approaches to long-term care.
  • Empowering individuals by educating them and giving them more options in their long-term care.
  • Engaging more stakeholders in the care value-chain in the seamless delivery of services through integration, leveraging technology and upgrading the skills of care professionals.
  • Starting a ‘Singapore conversation’ about long-term care both bottom-up and top-down in society discussing our hopes, concerns and fears in long-term care.

Mr Lee of the Lien Foundation concluded: “Transitioning to eldercare can be a stressful and emotional journey for the elderly and their families. To evolve a person-centered eldercare system, we need to focus on managing the ageing process with emphasis on well-being and happiness.”

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