The Potential of ICT in Supporting Domiciliary Care –

The Carer Perspective.

The case of Germany

Heidrun Mollenkopf, Ursula Kloé, Elke Olbermann & Guido Klumpp

Brussels, January 19th, 2010

Workshop "Long-term care challenges in an ageing society: the role of ICT and migrants "

Dr. Guido Klumpp

Executive Director of the German National Association of Senior Citizens’ Organisations (BAGSO)

Ursula Lenz Press officer (connections with member organisations)

Dagmar Kratz Chief accountant (administrative and financial organisation)

The German Team

Dr. Heidrun MollenkopfSociologist and gerontologist. Member of the BAGSO Expert Council.Former Senior researcher at the German Centre for Research on Ageingat the University of Heidelberg.

Ursula KloéSocial Researcher / Market Researcher /Consultant on behalf of industry and market research institutes. Self employed.

Dr. Elke OlbermannPhD in Sociology, Senior Researcher at the Institute of Gerontology, Technical University of Dortmund

The Potential of ICT in Supporting Domiciliary Care

The context of ageing and care in Germany

ICT initiatives: interesting cases (Service Provider / Senior Centre)

ICT in domiciliary care

Research and policy implications

Overview:

In order to elaborate the study, we used a

multi-methods approach

• Desk research (scientific literature, policy reports, projects, media, web sources)

• Investigations based on questionnaires (mail expert interviews) with persons involved in the organisation of domiciliary and institutional care;

• In-depth (personal or phone) interviews with outpatient care service providers and professional care workers (with and without migration background)

• In depth (phone) interviews with persons working in R & D projects addressing ICT in care.

Approach, Tools and Sources

• In-depth personal interviews (case studies) with informal caregivers(with and without migration background)

(1) The Context of Ageing and Care in Germany

Table 1. People in need of care 2007 (number, settings and level of care)

2.25 million people in need of care in 2007

Care in domiciliary settings1.54 million people (68%)

Institutional care709.000 people (32%)

exclusively through family members

1.03 million people

through professional nursing care services

504.000 people

according to Grade of dependencyGrade I: 61.8%Grade II: 29.9%Grade III: 8.3%

according to Grade of dependencyGrade I: 52.5%Grade II: 35.4%Grade III: 12.1%

according to Grade of dependencyGrade I: 35.7%Grade II: 42.3%Grade III: 20.5%without classification 1.5%

accomplished throughinformal care (family, social

network, legal as well as 'grey' market)

accomplished through11.500 outpatient nursing

care services with236.000 employees

in 11.000 nursing homeswith

574.000 employees

Source: Pflegestatistik 2007. Pflege im Rahmen der Pflegeversicherung. Deutschlandergebnisse. Statistisches Bundesamt Wiesbaden, 2008.

• 68% of the people in need of care are getting care at home• Outpatient care in Germany is largely provided by private and

non-profit organisations (98%)• Most care personnel is female and working part-time

The German Social Long-term Care System

Main characteristics– Organisational and financial segregation of Health care and Long-term care

The German Health Care / Social Long-term Care System is characterized by fragmentation & lack of integration and transparency.

LTC:– Benefits dependent on 3 grades of dependency – Legal separation of formal and informal caregiving– Separation of medical treatment and care assistance/home help – Benefits in kind or in cash for self-organized support– Nursing aids and technical aids– Support of family caregivers

(Professional domestic care in the absence of caregivers, unpaid leave)

(2) The Contribution of ICT in Domiciliary Care

ICT initiatives: interesting cases

'Viertes Viertel' Senior Centre Güstrow

'SOPHIA' Service Provider

Interesting cases (1): Senior Centre Güstrow 'Viertes Viertel'

Foto source: Bundesministerium für Familie, Senioren, Frauenund Jugend (BMFSFJ) (2008). Das intelligente Heim. Ablaufoptimierung, kurze Wege, Entbürokratisierung. Bericht über das Modellprogramm. Berlin: BMFSFJ, page 54ff

Although an institution, there are interesting starting-points for future developments to support domiciliary care:

• Leading idea: 'living together' like at home. – Single rooms / high flexibility with furniture to create a feeling of being at home– In every house unit: 11 inhabitants + 4 'care assistants present' (Pflegepräsenzkräfte)– Care workers for persons in need of health care

• Innovative technology to support independence and safe everyday life– Household appliances, e.g., induction cookers and steam ovens – Intercom system with several call- and question/answer-possibilities– access control, smoke/fire detector) in private homes with link to the service office.

Interesting cases (1): Senior Centre Güstrow 'Viertes Viertel'

• Positive experiences if older persons are guided and trained.

Foto source: www.sohia-nrw.de

Phone or

TV

Personalcontact

TV

SOPHIA is a Franchise System, growing all over Germany

Interesting cases (2): Service Provider SOPHIA

• Availability: 24 hours a day, 7 days a week• Covering a wide range of needs

– Organisation of outpatient care or craftsmen / Mediation of supporters / suppliers• Personal 'godfather' for every participant

(based on voluntary work – some of them with migrant background)– Calls at least once a week to chat and to check necessary tasks to be done

• Use of telephone + TV as well as innovative ICT– TV / PC for video communication to connect people with the outside world– Safety devices like emergency bracelet/watch / alarm system / smoke / fire / water

detector.

Service system for persons who want to stay at home

6 Packages: Basis – Safety – Home security – Comfort – Family

Interesting cases (2): Service Provider SOPHIA

(Costs between 21 € and 50 € per month)

• Despite diverging openness: Users show overall satisfaction.

In the beginning, older people show distance towards innovativetechnology, but ---

--- older people are happy to use technologies

– if technologies address their needs– if technologies are accompanied with social attention and support– if the older people receive the necessary training.

Interesting cases (1 + 2): Main findings

• Technology has the potential to support home care in favour of all persons concerned.

First attention and contact mostly through (younger) relatives ---

--- Family carers are relieved of parts of their burden.

(3) ICT in Domiciliary Care: Consultation of Experts

High interest in innovative ICT especially for organisation and documentation (mobile units with connection to central unit)

Advantages: Fast communication, saves time, permanent availability, reduces bureaucracy, releases time for care

Consequence: Centralization of kowledge.

General use of Internet for information about care / health problems / legislation / professional issues etc.

Experts' (care workers') interest and use of ICT

Barriers

Older people

• Low readiness to inform oneself before being in need of support / care• No knowledge about possibilities and costs / funding possibilities• Fear of being dependent on or not being able to use technical device• Use of technology is seen as acknowledgement of needing support

• Lack of information / time / money for selection and installation• Limited opportunities for information, counselling, training• Lack of adequate training material (e.g., in mother tongue)• High fluctuation of empoyees• Lack of interest and lack of acceptance of ICT

Experts' Comments: Barriers

Care Services

Consequences • Difficulties to train employees adequately

• Difficulties in using appropriate ICT

• High concentration on human services

• Innovative ICT has to go on from what people already use or know.

Barriers

Family caregivers as well as outpatient care providers consider the tasks that migrant care workers perform in home care essential for the well-being of the people in need of care.

ICT in Domiciliary Care: Informal Caregivers.

• High legal insecurity • Reduced social rights • Great variety of tasks • Irregular working hours • Little leisure time • Limited social networks.

High regard of tasks performed in home care

General situation of carers with migrant backgrounds

Informal Caregivers. Overview (1)

Sociodemo-graphy

Education

Residence in Germany

Woman from ...

Care career / status

Romania Poland (1) Poland (2) Poland (3) Germany (Turkish Origin)

Germany

55 years Married

28 years Married

32 years Single

25 years Single

28 years Married

42 years Married 2 children

Univ. entr. qualification

Training as technician/ designer

Univ. entr. qualification

Since 2006 training as nurse

Secondary school

Grammar school/ training incompl.

Secondary school

Hairdresser

University training

Nursery teacher

Social educ. worker

Univ. entr. qualification

Training as bank clerk

Since 2005 Since 2002 Since 2000 Since 2002 Since birth Nat. German Since 2005

4 care households

2005–2006: illegally employed

Since 2007: legally empl.

Now: looking for new job

2002/ 2003: Woman of advanced age

Illegally employed

Since 2000: 3 care house-holds

2000-2007 illegally empl.

Since 2008 legally empl. in care center (care assist.)

Since 2002 3 care house-holds (of Polish origin)

2002-2007: illegally employed

Since 2008 legally empl. domestic help (ZAV)

Since 2007 mother in law

Care together with brothers / sisters (in law)

Since 2006 for father, since 2007 both parents

Housekeeping / care in coop. with outp. care serv.

6 km dist. own home parents

Informal Caregivers. Overview (2)

ICT in care households/ private use

Requests / ideas for ICT

Woman from ... Romania Poland (1) Poland (2) Poland (3) Germany (Turkish Origin)

Germany

ICT for communication with relatives of person in need of care Restriction to technical devices availabe in household of person in

need of care

Focus: competences and barriers towards ICT of person in need of care

Telephone One case:

PC/Internet access

Now: tele-phone, mobile, Internet/e-mail of her own

Telephone Babyphone Mobile

(prepaid) for calls to Poland

Telephone, mobile for emergency calls, Inter-net access

Telephone, babyphone

Private calls must be paid

Telephone Mobile

phone for private use

Mother: mobile (big keys, program-med; attached to key ring)

Family(several

times / day): telephone chain, e-mail, sms

Telephone Parents re-

ject mobile Daughter:

internet for information e-mail (outp. care service)

ICT offers in native language Internet access (e-mail) / phone to stay in touch with family at home

Focus: easy access for person in need of care

Online information about o care/health problems o behaviour in emergency

Nothing specific

GPS Easy to use mobile

Online com-munication (e.g. doctor)

E-learning (German language, care)

o cultural peculiari-ties

Summary: Informal Caregivers' Requests / ideas for ICT

• ICT for communication (via internet) and coordination of tasks (with doctor, care workers, relatives of person to be cared for);• Internet access for information about care / health problems / behaviour in case of emergency / cultural peculiarities.• e-learning: German language, issues related to domiciliary care (Condition: training and communication possible in mother tongue).

• Easy to use mobile phone for older persons• GPS system for persons with dementia

Informal caregivers: General trends• High level of education• Trend to legalisation and professionalisation

Requests and wishes for ICT:

Family carers are more concerned about offering suitable ICT solutions to care recipients while (migrant) care assistants are more concerned about improving quality of their work.

Equipment with more modern ICT depends very much on the interests, openness and competences of the principal actors.

Innovative ICT has to go on from what services already use / employees know / older people are acquainted with.

(4) Conclusions: Requests for ICT Development & Training

Conclusions & recommendations (1)

Education / vocational training should integrate the use of innovative ICT

• Time and opportunities for learning has to be provided • Concrete (mother tongue) information in the Internet about home care and potential technical support is needed • Adequate multi-lingual training material has to be developed.

Raise general awareness, de-taboo the issues of care, illness & dementia

• Information campaigns in television and internet.

Education

General

Awareness

Create more transparency / overcome the fragmentation of responsibilities related to

Conclusions & recommendations (2)

Improve technologies and systems• Overcome barriers arising from unsuited design• Avoid stigmatising technologies•. Develop ICT and technical applications that are independent of language.

Conclusions: Requests for ICT Development & Policy Actions

• Health care & Long-term care system / legal regulations • Reimbursement possibilities and conditions.

Create a centralised / systematic/ multilingual online platform• addressing all of these issues + providing information about available technologies / services / possibilities of support.

Legalise the societally important work of caregivers from migrant backgrounds.

System

ICT

Organisation

Legalisation