Aged care has long been a product of the interacting worlds of social care and health. As it looks to its future, there are many sources of positive change and disruption to consider. There are many opportunities to enable and enhance the continued independence of older Australians and their communities. It is important to make space for community and industry reflection in order to translate existing and emerging knowledge into ‘value’. Value-orientated innovations can lead to more sustainable practise and better outcomes and experiences for consumers and citizens.
The changing face of aged care is the product of history, as well as current trends. Some of the disruptive trends have been around for some time (e.g. de-institutionalisation and ageing in place), and some are more recent (e.g. smart ageing). This resource focuses on nine areas which present plausible opportunities for change and re-imaging of aged care across Australia.
De-institutionalisation of care navigates the development of the ageing in place and building-free care principles.
Innovative service provision and assistive technologies are increasingly making it possible for older people to continue to lead an independent life, in their own homes or within their communities. Home-based care is an increasingly attractive market area – globally, it is expected to reach a value of $355 billion by 2020, and to grow by an average of 8% a year. The relative cost saving (compared to residential care) and the desire to “age in place” are driving its take-up and expansion .
The environment in Australia is ripe too – a 2010 survey found that almost 60% of people aged 70 years or over would prefer to receive formal care at home in the event that they are unable to care for themselves, compared to 28% who would prefer to receive residential care . This is also reflective on current service make-up of the aged care sector . Advances in wireless sensors and other digital monitoring technologies are enhancing the creation of solutions that can be easily incorporated to day-to-day living and enable older people to live longer and independently in their own homes.
Digi-cities for living
In Singapore, ageing in place is a strong preference of older citizens. There, iCityLab, a research facility focused on developing technology for ‘smart cities’, in partnership with Singapore Management University and Tata Consultancy Services, is trialling 50 social housing flats which have been set up as smart homes for the elderly. Homes were fitted with a range of sensors to monitor the resident’s movements and detect whether the main door has been opened. The system can detect if the person has spent a lot of time in the same area of the home – indicating a possible fall, for example – or if they have been inactive for a prolonged period. It will then alert a family member or carer to come and provide assistance. iCityLab is also trialling a medication box equipped with sensors as a way of tracking the person takes their medicines as prescribed. Again, carers are alerted if there is any deviation. The long-term goal is for the system to be able to monitor elderly people continuously, not just within their homes. This would enable ‘pre-emptive care’, which involves identifying potential health issues early and attending to them before they become a more serious problem .
Digital enhancing for life
In Australia, Deakin University is leading the ARC Research Hub for Digital Enhanced Living. Researchers are drawn from a diverse range of disciplines (such as nursing, aged care, palliative care, health informatics, sport and exercise science, human computer interaction, pattern recognition and data analysis and software engineering). They are working on ways to integrate sensing and interaction technologies, with platforms for linking heterogeneous data type and sources, and with artificial intelligence (AI). The aim is to create solutions that will enable older people to maintain their independence, improve their social connections, and improve their physical and mental wellbeing. They hope that their work will eventually form part of a larger health delivery system and that new service industries for in-home care support will result from technological advances, including care plan and device development and configuration, maintenance and remote monitoring .
But not all solutions supporting people’s preference to live independently in their own homes are technology-based. Health and aged care providers and systems are embracing the concept of smart ageing and creating new services and adapting policies to match the expectations and preferences of those experiencing physical and social limitations relating to their ageing. It’s about empowering rather than managing.
Falling is in the past
In the Netherlands, older people are choosing to learn how to fall, over abdicating from their preference to live in their own homes, often alone. Courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity. Hundreds of these courses are being taught by registered physio- and occupational therapists across the country. Some health insurance schemes cover part of the costs. In one course, called “Vallen Verleden Tijd” (which roughly translates as “falling is in the past”), students meet twice a week. On Tuesdays, they build confidence by walking and re-walking an obstacle course. And Thursdays are reserved for the actual falls. There is also a social aspect to the course, as students (as usually happens within group learning activities) create personal bonds with their peers .
In Denmark, a 2015 law has completely reframed what providing support for the elderly means. The default support service provided by the government to senior citizens living in their homes is “reablement” rather than traditional help services. Reablement is a short-term, goal-oriented intervention with the aim of strengthening the person’s functional ability. Services are provided by multi-disciplinary teams of social care workers, physio- and occupational therapists, dieticians, nurses, etc. Compensatory home help services are only offered if it has been assessed that the older person does not have the potential for reablement .
3.2 Re-imagined communities
Re-imagined communities encompasses community-led planning and democracy, and planning for people not infrastructure
The ageing of the world’s population has created the need to rethink the way societies have so far thought about ageing. Older people want and should be recognised for their capabilities, availability and willingness to enhance their own wellbeing and improve their communities. Around the world a number of projects and innovations are being implemented to make cities and communities more responsive to the needs and aspirations of its elders.
Community-led or whole-of-community initiatives from around the world
Canada – the concept of “pocket neighbourhoods” – a pattern of housing that fosters a strong sense of community among nearby neighbours, while preserving their need for privacy – is gaining traction in cities such as Toronto . Barcelona, Spain – under the direction of its Elderly Advisory Council, the city is installing outdoor escalators to improve mobility and access. Chiayi City, Taiwan – its municipal authority pioneered the concept of “health groceries”—neighbourhood centres for older people offering a lunch club, healthcare talks and check-ups, plus workshops and group activities. New York, USA – the city is implementing a variety of measures in consultation with older residents. For example, benches with sectioned arm rests and space for shopping have been installed around the city, so that elderly people can more easily rise to a standing position and lift their carrier/shopping bags. New transparent bus shelters and have been installed (sponsored by advertisers), so that older users feel safe and can sit down while waiting for transport. Corner shops (upon agreeing to offer regular glasses of water) can apply for an “age-friendly” designation and receive folding seats that can be used by their elderly customers – they have enjoyed a sales boost as a result. There are also lists of age-friendly swimming pools (with ramp access) and colleges offering life-long learning opportunities for older students .
This need has been met not only by innovative and inclusive planning of spaces, but also by innovative community-based solutions, social networks and community awareness initiatives that support increased social and economic participation amongst older populations and better intergenerational collaboration.
Self-helping networks and communities
In Vietnam, one of the most rapidly ageing countries in the world, intergenerational self-help clubs are being used as a way of supporting older people to lead dignified, healthy and secure lives. The clubs are a community-based space where older people can access health check-ups, get help to start a business or generate an income, find out information on their rights and build social networks. They also organise training on self-care and first aid for both club members and the wider community, and provide outreach homecare support services to those who need it, such as the bed-bound and disabled. This type of solution, more generally called older people’s associations (OPAs), is becoming a trend in Asia, working across a range of domains and having older people as leaders and volunteers.
Open collaboration and connection
In Japan, which has the world’s fastest ageing population, grassroots initiatives are helping to make communities dementia-friendly. Different models have flourished, but the key feature of all initiatives is that they are local, based on voluntary support and are unencumbered by restrictive bureaucracy. One model is the “open house” provision. Open houses are either a volunteer’s own house, or a low-cost rented house. They generally offer informal advice and peer support for carers. In one of the open houses, “Suzu-no-ya”, for example, local residents with dementia and their carers can access all-day care including lunch and tea. Neighbourhood-watch style networking is another type of initiative, led by volunteers in partnership with the police, local businesses and charities. They look out for people with dementia who seem to be lost or confused. They initiate simple conversations with the person to determine if he or she is ok or need help to get back home. The government is also implementing a national plan to train the general community in dementia awareness. Classes are less than 2 hours long and are customised to address concerns from each group of attendees. The intention is to help postal workers, pharmacists, and others who are more likely to interact and care for people with dementia. The hope was to reach 8 million trained people by 2017.
The residents of a small town in Belgium, Geel, have been welcoming people living with mental health disorders and conditions, including those at the more severe end of the scale, into their homes and caring for them. It is part of a town tradition that started over 700 years ago. The people they host are not called patients, but guests or boarders. Before being matched with a household, they are evaluated and treated by medical professionals in a hospital that manages the program. Hosts receive a stipend from the Belgian government for participating in the program, as well as training and support from psychiatric professionals. One of the reasons the model seems to have succeeded for centuries is that residents of Geel have learned to live with the behaviours of the boarders, constantly coming up with creative ways to help balance enablement and care management needs.
3.3 Value-based care and health
Value-based care and health references integrated care and person-centred business models and practise are implemented at the individual, organisation and/or system level.
There is a worldwide trend of achieving more value for the customer with less resources and lower costs to the community. This is shaped by the need to compete for more astute and demanding consumers, whilst overcoming resources scarcity in terms of skilled workforce, environmental resources, etc.
One example of this trend is the introduction of contestability policies by government, with the aim of promoting the adoption of a commercial mindset for the public delivery of a range of services from utilities to human services. ‘User choice’ policies that transfer the purchasing power of outsourced public services from government to consumers (e.g. education, health, disability, and now aged care) are another example. Another associated trend is payment for results rather than for single products, procedures, or activities. Within health and aged care, this means being focused on improving value for end users (where valued outcomes are defined by end users and their families), relative to the cost of achieving those outcomes.
This value-based care idea is gaining traction with health providers, government and the insurance industry in the US and in Europe. The concept of value-based care originated from Michael Porter (Harvard) and Elizabeth Teisberg (Dell Medical School, University of Texas) 2006 book Redefining Health Care , and since then industry leaders and academic researchers around the world have developed the tools to support its implementation, including new ways of:
□ interdisciplinary care teams organised around the patient rather than having them separated in specialist/professional silos and integrated care across locations;
measuring and monitoring
□ outcomes and quality that matters for end user rather than compliance; and
□ funding models that directly rewards improving the value of care, such as ‘bundled payment’ .
Enhancing healing potential
In health care, values-based means delivering more than clinical results. For example, survival rates for cancer patients who had their prostate removed is around 95% in Germany. Surviving, however, does not mean regaining the same quality of life that they had before the surgery – around 43% of men suffer incontinence, and 76% report severe erectile dysfunction one year after surgery. Martini-Klinik, a pioneer in adopting a value-based approach, has achieve much better results – incontinence and erectile dysfunction rates are as low as 7% and 35% respectively. Their recipe is employing multidisciplinary teams to provide integrated care (i.e. patients receive all the care they need at a ‘prostate cancer centre’ rather than being shifted from department to department), measuring outcomes that matter to both patients and clinicians, and systematically analysing outcomes data to drive continuous treatment improvement. This approach has also ensured a high patient satisfaction rate of 98%. Having built international recognition in prostate cancer treatment, Martini-Klinik attracts increasing numbers of patients from all over Europe .
Buying outcomes, not services
In the US, care delivery is moving from fee-for-service to value-based reimbursement systems. Many providers are already adapting their operating models – a recent survey by Deloitte indicated that 27% of health providers have completed pilot programs or are at some stage of rollout . For example, Cleveland Clinic is implementing an Integrated Care Model, designed to improve the patient experience of care (including quality and satisfaction), improve population health, and reduce the cost of healthcare. Supporting this, real-time data is collected, analysed, and shared with caregivers and the public, to drive constant performance improvement in quality, safety, utilisation, cost, appropriateness of care, and patient and caregiver experience . Another US example is the Comprehensive Care for Joint Replacement model, started by the Centers for Medicare and Medicaid Services after realising that billions were being spent on these procedures, with varying results among patients and health care providers. The model aims to hold providers accountable not only for the quality of care they provide for hip and knee replacement, but also for how well patients do 90 days after hospital discharge .
3.4 Personalised servicing
Personalised servicing provides perspectives on product, service, delivery and payment modes and how they are used to tailor to specific individual preferences and needs.
Increased use of online platforms for communication, self-expression, information and commercial transactions has resulted in a world where customers have more information, more choice, more visibility, and therefore more influence over the decisions of fellow customers and over business trying to offer attractive services and products.
Business can no longer expect to attract and retain consumers by relying on their brand alone. Successful ones are unlocking the value of data analytics to design tailored services and products and personalise customer engagement in order to increase customer satisfaction, and optimise their profit margin potential and market relevance. As more and more health and aged care providers move to a value-based model, there will be a shift of focus away from providing acute episodic interventions. Increased attention will be placed on enabling people to achieve vitality and wellbeing in an ongoing, whole of life provider-customer relationship. This will increase the focus on human-centred design and user experience thinking .
A 2016 US survey found that 44% of healthcare organizations reported having a chief experience officer (CXO), and a 2017 worldwide survey found that 58% of hospitals and health systems now have CXOs, up from 22% in 2013. CXOs are responsible for enhancing process improvement with experience mapping and design, ensuring that empathy and human connection are embedded in new improved processes. To do this, CXOs rely on operational and health, well-being and satisfaction measurement and analytics, and engagement of people across the system (front-line staff, providers, patients and families) around the end goal of improving users’ outcomes and system experience.
Low tech solutions can change the world
Rotterdam Eye Hospital, in the Netherlands, has a design-thinking team. The team identified that reducing patients’ fear was key to the success of eye operations. By studying patients’ characteristics and existing processes, the team has come up with relatively simple modifications that have proven to significantly improve patient experience. Projects include building a more intuitive website, replacing harsh ﬂuorescent lighting and cold linoleum ﬂoors with softer lighting and wood parquet, and giving children and paediatric ophthalmologists matching T-shirts. The team has also identified the most common patients’ behavioural profiles and designed tailored verbal and non-verbal communication strategies.
My home, my way
The Green House Project in the US has created a model that gives residents much greater levels of autonomy and freedom than more traditional residential care homes. It runs 204 homes, each designed to blend into the neighbourhood and to be practically indistinguishable from other homes in the community. Residents have control over the decorations and are allowed to furnish their rooms with as much of their own belongings as they would like. Meals are designed and scheduled according to the individual preferences of each resident. In terms of running the homes, traditional organisational hierarchies have been banished; each staff member authority to address resident requests and come up with solutions to meet their needs. The resident gives permission.
Linked trends – Value-based and personalised servicing
A large part of value-based care is measuring what matters for the end user and using this knowledge to design a consumer experience that will deal with the patient’s concerns and experience of their condition in a holistic and integrated way.
In the US, Patient-Centered Medical Homes are starting to apply a Integrated Practise Unit (IPU) model to primary care. Traditionally, primary care practice applies a common organizational structure to the management of a wide range of patients, with very heterogeneous needs. This makes outcomes measurement very difficult, which does not help with value improvement. In the IPU model, multidisciplinary teams organized to serve groups of patients with similar primary and preventive care needs. These teams can specialize their services and address lifestyle change and preventive care in a way that is tailored to patients’ overall circumstances. This greatly facilitates outcomes measurement and constant improvement of services. Geisinger Health System, in Pennsylvania, is one example of this model being implemented. There, the care teams for patients with chronic conditions such as diabetes and heart disease include not only physicians and other clinicians but also pharmacists. The interdisciplinary teams have achieved fewer strokes, amputations, emergency department visits, and hospitalisations.
3.5 Shared-value operating and investing
Shared-value operating and investing examines the emergence of business models with the singular pursuit of social benefit, and not commercial gain.
Business around the globe are increasingly focusing their value proposition on solving social or environmental issues. This is the result of a number of factors, including a declining trust in government’s ability and capacity to tackle all existing issues; customers’ increasing awareness and higher expectations towards companies they interact with; and investors being able to identify business models that provide an opportunity to generate profits whilst generating social good.
A recent survey found that most Australians (56%) distrust government more than they distrust business (6%), when asked to pick which one is the ‘most broken institution’.
Illustrating the growing consumers’ expectations, the majority of Australians (65% and 63% respectively) believe that CEOs should take the lead on change rather than waiting for government to impose it, and that a company can take specific actions that both increase profit and improve local social and economic conditions. Almost half (49%) think that companies that focus only on profits are bound to fail. Responding to these expectations, corporations are applying their abilities to create and operate complex supply chains and to serve large and diverse customer populations to the task of solving social problems.
Social benefit at scale
General Electric (GE), for example, created ‘Healthymagination’ in the mid-2000s, to explore new partnerships and technologies to deliver better and more accessible healthcare. It has so far launched dozens of new healthcare products, which have improved people’s lives (e.g. it created a $500 device that has allowed Indian physicians to give cardiology scans for the cost of a bottle of water, and Embrace, a $200 incubator that is saving the lives of premature babies born in developing nations), while generating profits (its healthcare portfolio generated $18.3 billion in revenues and $2.8 billion in profits in 2012) .
In Jan 2018, three of the biggest names in American business — Amazon (technology), Berkshire Hathaway (insurance) and JPMorgan Chase (finance) — announced a new venture to provide better, cheaper health care for their employees in the US. Some speculate they might be forming what would likely become the world’s largest ‘B Corporation’, a company legally obligated to serve society, not just shareholders . Jamie Dimon, the chief executive of JPMorgan Chase, said in a statement that the effort could eventually be expanded to benefit all Americans. The companies said they would initially focus on using technology to simplify care, and while they don’t seem to be sure of how to achieve their goals yet, they believe their combined access to data about how consumers make choices, along with an understanding of the intricacies of health insurance, would inevitably lead to new efficiencies and enhanced access. Mr. Buffett stated that “The ballooning costs of health care act as a hungry tapeworm on the American economy…Our group does not come to this problem with answers. But we also do not accept it as inevitable”. Jeff Bezos, Amazon’s founder and chief executive, said that “Hard as it might be, reducing health care’s burden on the economy while improving outcomes for employees and their families would be worth the effort” .
Realising health connections through data
Alphabet (the parent company of Google) is also working on a project, Cityblock Health, to improve health care accessibility and outcome for low-income populations in the US. Cityblock will analyse data to identify where care is most needed. It plans to hire 55 people over the next six months, including data scientists, software engineers and a lead doctor, as well as a team to interact directly with patients .
In Germany and in Japan companies from a range of industries are beginning to realise the promising market of lifestyle support services for older people – a market worth $7 billion AUD in Japan alone. Deutsche Post and Japan Post’s workers are helping to keep an eye on older citizens who live alone. Subscribers to the service pay a small monthly fee to have a post officer pay regular visits to monitor their health and wellbeing, and to notify issues to relatives or health and social services . Japan Post has also recently formed a joint venture with other companies (NTT Docomo, IBM Japan, Dai-ichi Life Holdings, advertising giant Dentsu, and security companies Secom and Sohgo Security Services) to expand its offering. IBM developed age-friendly tablets, through which older people can order items from local stores and supermarkets, and where daily health and treatment records can be entered. Japan Post Insurance and Dai-ichi Life will use the data to offer advice on healthy living. It is also hoped that the tablets will encourage interaction among the its network of users (older people), and provide them with entertainment through its radio, games and karaoke applications. The device will also be able alert the security companies on sudden changes in the person’s health and indicate when assistance is needed .
Other companies are focusing on addressing social or environmental issues in order to reduce operational costs – this is also creates shared value. For example, Nestle has put shared value at the centre of its mission and it has (amongst other things) reduced water consumption per dollar of revenue from 4.5 to 1.5 litres over 10 years. It has increased profit margins while decreasing environmental impact .
Companies also create shared value when they work to improve the local business environment, e.g. by building the capabilities of suppliers and civil institutions, or working to replace obsolete regulatory frameworks. An example would be the work that Mars and other buyers of cocoa did in Cote d’Ivoire – decreasing yields were driving farmers to change to other crops, and as a result supplies were decreasing and the price of cocoa was increasing. As a solution, cocoa buyers worked with farmers to improve plant stock, horticultural skills and farming practice. This improved the commercial environmental for Mars and its collaborators, but also improved general farming practices for the economy as a whole .
3.6 Networked servicing and operating
Networked servicing and operating which examines ways of collaboration and co-working to improve thinking, design, and delivery of services and products, independence and resilience, and resolve problems and create common benefit.
Increasing connectivity and the emergence of digital technologies across all industries are allowing companies and individuals to create and commercialise products and services through business-to-business and people-to-people supply chains. With advancements in digital manufacturing technologies, which allow on demand production, industries producing more tangible consumables, such as construction and manufacturing, are also adopting this way of working.
WikiHouse is an open-source construction system that allows anyone to design, share designs and build a house. With access to a computer numerical control (CNC) machine anyone could digitally fabricate the parts, which are then easily assembled with minimal skills, like a Lego or IKEA kit. WikiHouse aims to allow professionals and companies to cooperate in creating innovative, affordable, customised and sustainable housing systems. It also aims to equip individuals to perform tasks that were previously only accomplished by expert companies, changing the nature of the construction supply chain. Currently there are several WikiHouse projects being tested worldwide, including in Australia, where they have partnered with Southport High School, a government school in Queensland, to provide CNC workshops .
Within an integrated care context, this networked approach can take the form of a business-to-business or a business-to-consumer model. Regardless of the service model, its focus is to optimise chronic health management by linking medical treatment to support services, such as education and counselling for positive behavioural change.
Linking businesses and professionals to people with needs
Essential Care is a business-to-business care coordination and delivery application that enables care providers to create remotely integrated environments. It deploys integrated patient medical profile, telemedicine capabilities, and an intelligent call centre to enable coordination and collaboration amongst professionals and services (i.e. skilled nursing home, assisted living, independent living, home health, hospice, palliative, hospital, ACO, pharmacists, specialists, and other care providers and settings) around a patient or customer .
The increasing centrality of both digital connectivity and data analytics for many business (and government) solutions has also opened opportunities for collaboration between the information and communication technology sector and many other industry sectors trying to draw on the expertise of data scientists, developers and designers to find solutions for their specific issues. Hackathons and technology hubs are sprawling across the globe, with the aim of sparking new, unusual partnerships and innovative ideas.
Linking ideas and funding
In India and in Brazil, for example, the World Bank Group has launched TechEmerge to match technology innovators globally (selected through a competitive open application process) with local health providers and fund their jointly developed pilots aimed at improving care and reducing costs .
Linked trends – Networked servicing and shared-value operating
In March 2018, Uber launched Uber Health in the US, as a way to partner with healthcare organisations to provide reliable, comfortable transportation for patients. The service hopes to eliminate a major social issue – every year, 3.6 million Americans miss doctor appointments due to a lack of reliable transportation, with the greatest barriers to transportation being faced by vulnerable populations, including patients with the highest burden of chronic disease. The service originated from the initiative of a health provider, MedStar, which approached Uber seeking a cheaper and more reliable alternative to regular taxis. Currently, over 100 healthcare organisations in the U.S, including hospitals, clinics, rehab centres, senior care facilities, home care centres, and physical therapy centres are already using the application. Health providers have reported cost savings with reduced no-shows and improved workflows, and patients have one thing less to worry about.
Digital-preneurship explores the embracing of new digital technologies to enhance business operations, business models, business data, and customer engagement.
From a workers’ perspective, digital connectivity is making it increasingly easier to operate in an autonomous way, coordinated and directly connected to consumers through digital platforms. This is a disruption to more traditional ways of organising the workforce, where employers act as a middleman, hiring workers and creating workflows in an attempt to balance supply and demand in a cost-effective way. On-demand digital platforms do this balancing work by matching consumers to personnel with the help of data analytics. These platforms also provide a direct link between them, reducing overhead costs and making services more directly accessible.
Companies in Australia (e.g. Ubercare and Better Caring ) and elsewhere (e.g. Honor, founded by a former Google employee ) are adapting the Uber model to offer on-demand care services. Through this model, carers can be booked round the clock, via an app, on a pay-as-you-go basis for whatever time is required. There are no limits to what these platforms could offer, from nurses to help with house chores, to simple companionship. They would also offer an opportunity for those interested in flexible, gig-type work, such as students, retirees, or people working part-time, etc. There is also the expectation that those working through these models would be better remunerated, as a consequence of reduced overhead costs.
Got a spare bed?
Another inspiring model is the one popularized by Airbnb, where people can sell access to resources they own, in this case, accommodation in their homes. CareRooms, in the UK, is trying to link hosts – anyone willing to rent a spare room – to former patients seeking a home setting to recuperate from hospital. Medical monitoring and care is provided by professionals (from partner health providers) via telehealth equipment installed by CareRooms, while the host is required to heat up three microwave meals each day and supply drinks to the patient. The initiative is expected to not only free beds in the public health system but also to improve patients’ recovery, as, according to Dr Thirkettle who is the co-founder and chief medical officer of CareRooms, there is good evidence on the negative effects of long-term hospitalisation on muscle strength, mass, and cognition. The company hopes to initiate piloting later this year .
3.8 Data for enabling
Data for enabling which discusses the next generation of data utilisation by organisations and businesses which moves beyond the paradigm of compliance and reporting towards an empowering and enabling data culture for customers, workforce and stakeholders alike.
Applications within mobile devices, sensors, telehealth devices, wearables, and even social media and websites collect a huge amount of data that, if wisely used, could provide tremendous opportunities for understanding individuals at a personal level. This might include the issues they face and their causes, what engages and motivates them, and what strategies could help them to lead more interesting and healthier lives.
Within health care, a system by which people could easily access their health data (ideally linked from the multiple health and care providers, applications and devices collecting it) would give people greater knowledge of their own health and an increased potential for them to participate in its improvement.
My health file
In Sweden, all residents older than 15 will have access to all information documented in government funded health and dental care by 2020. All its hospitals, primary care centres, and psychiatric facilities in the country already use electronic health records. People will be able to log in to the ‘Journalen’ system using either an electronic identifier or their Swedish personal identity number. The ‘Journalen’ will contain notes from all healthcare professionals, a list of prescribed medications, test results, warnings, diagnosis, maternity care records, referrals, and vaccinations as well as a log of everyone who has accessed the record. The owner of the data, residents of Sweden, will also be able to add comments to note if, for example, they believe information is incorrect . Studies have shown that patients with such access have a better understanding of their illnesses, and that their treatment is more successful. Trials in the US and Canada have also demonstrated such access produce happier patients and reduce care costs. In January 2018, Apple announced ‘Health Records’, a feature embedded in its Health app to be introduced in the US with the next big software update for the iPhone. The feature would allow users to view, manage and share their medical records, by bringing together medical data from participating hospitals and clinics, as well as from the iPhone itself .
The emergence of ‘digiceuticals’ or ‘digital therapeutics’ is another sign that technology, data analytics and customer appetite are coming together to create a world where people are more in charge of understanding and managing their own health. The term refers to digital applications for managing chronic health conditions which have been tested for efficacy, and approved by regulatory agencies, e.g. Food and Drug Administration (FDA in the US, and are prescribed by a general practitioner or other specialist doctor. Most digiceuticals gather data (either by asking patients for information or by using sensors) and provide real-time guidance . The promise is not only to improve health through continuous monitoring and personalised interventions, but to create greater access through more affordable technologies and reduced government burden relating to the management of chronic disease.
Digital health applications and games are on the up
The FDA has been approving a growing number of digital health applications to treat everything from diabetes to substance abuse. Last year, it hired new digital health experts and launched a digital health software pre-certification programme to streamline the regulatory process .
The start-up Pear Therapeutics has a pipeline of treatments at various stages of development, with a product development model similar to that of a conventional pharmaceutical firm. They are trying to develop apps aimed at treating a range of conditions: opioid addiction, schizophrenia, anxiety, insomnia, post-traumatic stress disorder (PTSD), depression and chronic pain. Their reSET app, for example, treats disorders involving the misuse of alcohol, cocaine and other stimulants. It does so by training patients to recognise daily triggers and cravings and to monitor and track these with their doctor. It has been approved by FDA for commercialisation and should be on the market in 2018 .
Akili Interactive Labs is conducting randomised control trials to advance a pipeline of programs across neurology and psychiatry for treating Attention Deficit/Hyperactivity Disorder ADHD, depression, Autism spectrum disorder and multiple sclerosis/inflammation. The Lab has developed, for example, video games designed to directly treat cognitive dysfunction associated with a range of medical conditions .
Some digiceuticals are developed to enhance the efficacy of regular pharmaceutical medicines. For example, Propeller has developed an information-powered approach to respiratory management that uses inhalers geared with sensors and digital analytics to provide personalised insights to help prevent episodes, reduce drug usage and improve user’s health .
There is also hope that hospitals and health care providers in general will be able to use this data to continuously optimise, redesign or create new clinical processes, management systems and infrastructure that will be able to achieve more efficient patient care (e.g. by improving diagnostics and reducing medical errors), whilst improving experience and reducing costs.
Disease monitoring AI
Alphabet, via its subsidiary Verily, is working on a study to track health data of 10,000 people (through surveys and wearables) over four years with the goal of developing an algorithm (artificial intelligence) that is able to predict when a person is going to develop a disease. The study is being undertaken in partnership with Duke University and Stanford University. The company claims to already be able to predict possible deaths of hospitalised patients two days earlier than current methods, allowing more time for preventative intervention . Last year, for example, Verily was working with a hospital near Manchester in the UK (the NHS Heywood, Middleton and Rochdale Clinical Commissioning Group), analysing pseudonymised patient records to look for patterns that suggest the emergence of long-term diseases like diabetes and alerting doctors if they are found . Alphabet (via its subsidiary Deep Mind) has also partnered with the Royal Free Hospital in London to test an AI that is able to steam and analyse live health data to identify patients at risk of sudden or fatal loss of kidney function .
A more widespread use of the combination of sensors and AI also holds the promise of moving the point of care from hospitals into everyone’s homes. In the US, it is expected that in 2018 22 million households will use virtual care solutions, up from less than a million in 2013. This number reflects both increase in the use of telehealth, but also an increase in the number of visits per adopter . But big data and AI might change the face of telehealth altogether. In the future, smartphones and wearables might become the point of care, with technology companies becoming providers of health care.
Last year, Apple announced it would join up with Stanford University to develop algorithms to spot irregular patterns in heartbeat data gathered by its watch. The company currently holds patents that would allow to turn its phones into full medical devices, using sensors around the camera and its touchscreen to let users measure their blood pressure, body fat and heart function. It is also looking into ways to measure blood glucose through its watch. Other patents envisage using both its phone and smartwatches to collect electrocardiograms to monitor heart health, and doing biometric monitoring through its wireless headphones .
3.9 Valuing care and workforce
Valuing care and workforce describes the re-evaluation by community and organisations around the idea of “what matters” – it explores the emphasis on enabling, encouraging and rewarding care.
As populations age and population growth becomes heavily reliant on migration, business and organisations will need to be able to attract and retain a diverse workforce, formed by different generations and cultural backgrounds. Particularly relevant to the aged care industry, businesses that thrive in utilising their older employees will be able to develop better products and services for their consumers and to market them more effectively.
To be able to attract and retain both care givers and older workers, companies that manage to position themselves as family friendly will have a competitive advantage. Younger workers alike are increasingly concerned about work-life balance and generating a positive impact through their work. Human resources practice will need to be adapted, starting from the recruiting process (e.g. mature workers are more likely to be attracted to ads emphasising experience, knowledge, and expertise, rather than energy, fast pace, and fresh thinking), but also professional development policies, which tend to target younger cohorts .
When new technologies start to become more common place within organisations, they will need to make a bigger effort to provide ongoing education to ensure continuous productivity. Training should be offered to all age cohorts – remembering that learners will have diverse base knowledge and expertise. If delivered effectively, it should engage all employees and pay attention to older employees who tend to be more loyal to their employers .
Older employees know older consumers
ARO Incorporated, a business process outsourcer based in Kansas City in the US, had issues with high staﬀ turnover, at 25% – there are around 90 call centres in Kansas City, so there is a lot of competition for employees. Their solution was to upgrade the company’s technology to allow teleworkers to work off-site, and to actively recruit baby boomers, who were attracted to the ﬂexibility. While some younger workers signed on initially, the company found that these employees missed having an oﬃce community and largely dropped out. Mature employees lasted longer and also proved to be a better match for the company’s customer demographics, who also tended to be older. For example, ARO does the underwriting work for insurance companies, which involves asking questions about the customer’s health, among other things. They found that this work is more effectively done by employees who were facing some of the same health concerns experienced by their customers .
Other companies are catering for older workers’ desire for ﬂexibility by reducing hours in the years leading up to retirement. Varian, a US-based leading provider of radiotherapy systems, has implemented a Retiree Casual program. Employees aged 55 and over who have a minimum of ﬁve years of service and who plan to retire within three years can negotiate a reduced work schedule. The typical arrangement is four days per week the ﬁrst year and three days a week thereafter. The arrangement has helped retaining employees past their retirement age but it has also helped personnel management in general. Staff needs vary from contract to contract, and the program helps level the staﬃng load. Monsanto has a similar program, the Resource Re-Entry Center. Any employee who has left the company in good standing are welcome to return to a part-time position.
Staff retention seems to be a problem in many countries within the health and aged care industries. In the UK, a poll by Wilmington Healthcare of more than 2,000 nurses, GPs and hospital doctors found that 64% blamed staﬀ retention problems on continuous changes in NHS workforce planning that had occurred since 2000. In the Netherlands, a group of nurses has taken the initiative to implement employee empowering approaches to solve similar issues.
Workforce redefining the work
Buurtzorg Nederland was founded in 2006 by a small team of professional nurses who were not satisfied with the quality of their relationships with patients, which they saw were being compromised by an increasingly complex health care system. They set up Buurtzorg, a patient-centred, nurse-led model to provide home-based holistic care. The goal is to help clients to achieve self-support and independence. Community-based nurses have a central role in the model, and are empowered to come up with solutions to handle specific circumstances for the client. Within each new neighborhood where a Buurtzorg is implemented, the team of nurses spend time introducing themselves to the local community and getting to know GPs, therapists and other professionals. They build-up their caseload through word of mouth and referrals. Teams are self-managed, and formed by people that are entrepreneurial in spirit, and motivated to continually improve services and the organisation as a whole. Although having a higher cost per hour compared to the traditional task-based approach, as a single nurse provide the whole range of care (from clinical, to cleaning and making sure there’s food in the fridge), the model requires fewer hours to deliver better outcomes for clients. With high employee satisfaction and client satisfaction rates, Buurtzorg has scaled from 1 to 850 teams in the Netherlands in just 10 years, and it is now active in 24 countries .
Celebrating age-adaptive workplaces
New York is about to announce the winners of its first Age Smart Employer (ASE) awards, defined on the basis of perks such as flexible working, training and professional development for older people, and initiatives such as mutually beneficial mentoring. This might include a younger employee teaching an older one how to use new technologies, while older employees might explain to younger colleagues how to offer personal service and foster relationships with customers .