Ageing and place
Considerations on the implementation of ICT for health and wellbeing in Ireland
Home Sweet Home Workshop Barcelona - 17th Jan 2013
Rodd Bond mriaiNetwell Centre, Dundalk Institute of Technology
The Netwell Centre and CASALA collaborate with governmental agencies, academic institutes and industry to:
• develop new ideas that enhance the quality of life and well-being of older people and those who care for them
• Through more integrated community-
oriented services, more sustainable home and neighbourhood design, and more affective and age-friendly technologies.
Individual & family’sQuality of Life
(QOL)
Home, neighbourhood
& cityQuality of Environment
(QOE)
Public / private& voluntary
Quality of Service(QOS)
Netwell/Casala ……
The Issues – national cuts
Reducing costs
Improving outcomes
Demographic pressure
Staff reductions
The Issues – local cuts
Reduction in opening hours
70,000 Home help hours
Health spending cuts
36 Bed closures
National & EuropeanPolicy areas
National Agenda
• Health Strategy• Positive Ageing Strategy• Carers’ Strategy• Dementia Strategy• Public Sector Reform• Local Government
Reform• Industrial Development• R&D
EU Agenda
• Smart, Sustainable & Inclusive Growth
• Demographic change• EIP: AHA, Smart Cities• Regional development &
competitiveness – smart specialisation
• Horizon2020-R&D• Social innovation
Weak funding !Capacity !Austerity !
Addressing weak implementation!Fragmentation !
Greater dependency on collaboration with the community & voluntary sector
Person at the heart
Care & Cure
Act
ive
Age
ing
Private services
Family
1. Cross sectoral alignments
2. Pathway integration
Person
Public services
Community/Voluntary
Prevention &
intervention
Connect
1st Principle - Citizen centric
Touch pointsMovements
The Age-Friendly Cities Movement
Health Services ReformStakeholder collaboration
User/citizen engagement
Social innovation
Connectivity / ICT
Dissolving boundaries
Health Service ReformMovements
ResourceRe-
configuration
Clinical quality
Front-line Extend organisational edge for self-managementEquitable access Financial balance
• Model for age-friendly city development
• Driven at a local government/community integration level• Leadership of individual county managers• National oversight and commitments
Buildings and outdoor spaces
Housing
Transport
Respect and inclusion
Social participation
Civic participation/employment
Information and communication
Community and health services
Connection:
Rural transport & urban mobility
Confidence:
Sense of safety & security
Empowerment:
Better access to better information
Alignment & Convergence:
Health, housing and care
Shareable places for all:
recognise frailty
Lifecourse:
Inter-generational solidarity
Energy for change:
Older people as a resource
Age-friendly cities / counties
(-)CVDRisk
(-)CVDRisk
(-)Blood
P.
(-)Blood
P.
(+)ThermalCom
f.
(+)ThermalCom
f.
(-)Stress
(-)Stress
EnergyEffic.
EnergyEffic.
FuelPov.
FuelPov.
Indoor Temp/
Indoor Temp/
Financial
security
Financial
security
HOUSING
Curriculum
Curriculum
Socialisati.
Socialisati.
SettingSetting
EDUCATION
(-)CVDRisk
(-)CVDRisk
(-)Obesity
(-)Obesity
(-)Chole
st.
(-)Chole
st.
(-)Blood
P.
(-)Blood
P.
(+)DietNutr.
(+)DietNutr.
Curriculum
Curriculum
Alcohol
Alcohol
Smoking
Smoking
Socialisati.
Socialisati.
SettingSetting
(+)Exercis
e
(+)Exercis
e
Socio-DemChar.
Socio-DemChar.
Neighbour.
Disadvant.
Neighbour.
Disadvant.
SECURITY
(-)CVD
Risk
(-)CVD
Risk
(-)Obesity
(-)Obesity
(-)Chole
st.
(-)Chole
st.
(-)Blood
P.
(-)Blood
P.
(+)Exercis
e
(+)Exercis
e
(-)Stres
s
(-)Stres
s
DisorderDisorder
Walking
Walking
FearFear
HealthyUrbanPlan
HealthyUrbanPlan
ENVIRONM.
(-)CVDRisk
(-)CVDRisk
(-)Obesity
(-)Obesity
(-)Cholest
.
(-)Cholest
.
(-)Blood
P.
(-)Blood
P.
(+)Social
(+)Social
(+)Exercise
(+)Exercise
(+)Air
Qual.
(+)Air
Qual.
(+)DietNutr.
(+)DietNutr.
NaturalEnvir.
NaturalEnvir.
WalkingWalking
BuiltEnvir.
BuiltEnvir.
Transportmobility
Transportmobility
Social Support
Social Support
Economic
Dev. Strategy
Economic
Dev. Strategy
MunicipalInvestment
MunicipalInvestment
Economic
Growth
Economic
Growth
Employment
Employment
Sociio Ec.
Equlity
Sociio Ec.
Equlity
Area basedInit.
Area basedInit.
Income
Income
ECONOMIC
WorkingCondit.
WorkingCondit.
(-)CVDRisk
(-)CVDRisk
(-)Blood
P.
(-)Blood
P.
(+)ThermalComf.
(+)ThermalComf.
(-)Stress
(-)Stress
EnergyEffic.
EnergyEffic.
FuelPov.
FuelPov.
Indoor Temp/
Indoor Temp/
Financial
security
Financial
security
HOUSING
CurriculumCurriculum
Socialisati.Socialisati.
SettingSetting
EDUCATION
(-)CVDRisk
(-)CVDRisk
(-)Obesity
(-)Obesity
(-)Cholest
.
(-)Cholest
.
(-)Blood
P.
(-)Blood
P.
(+)DietNutr.
(+)DietNutr.
CurriculumCurriculum
AlcoholAlcohol
SmokingSmoking
Socialisati.Socialisati.
SettingSetting
(+)Exercise
(+)Exercise
Socio-DemChar.
Socio-DemChar.
Neighbour.Disadvant.
Neighbour.Disadvant.
SECURITY
(-)CVDRisk
(-)CVDRisk
(-)Obesity
(-)Obesity
(-)Cholest
.
(-)Cholest
.
(-)Blood
P.
(-)Blood
P.
(+)Exercise
(+)Exercise
(-)Stress
(-)Stress
DisorderDisorder
WalkingWalking
FearFear
HealthyUrbanPlan
HealthyUrbanPlan
ENVIRONM.
(-)CVDRisk
(-)CVDRisk
(-)Obesity
(-)Obesity
(-)Cholest
.
(-)Cholest
.
(-)Blood
P.
(-)Blood
P.
(+)Social
(+)Social
(+)Exercise
(+)Exercise
(+)Air
Qual.
(+)Air
Qual.
(+)DietNutr.
(+)DietNutr.
NaturalEnvir.
NaturalEnvir.
WalkingWalking
BuiltEnvir.
BuiltEnvir.
Transportmobility
Transportmobility
Social Support
Social Support
EconomicDev.
Strategy
EconomicDev.
Strategy
MunicipalInvestment
MunicipalInvestment
EconomicGrowth
EconomicGrowth
EmploymentEmployment
Sociio Ec.Equlity
Sociio Ec.Equlity
Area basedInit.
Area basedInit.
IncomeIncome
ECONOMIC
WorkingCondit.
WorkingCondit.
Connecting the dots, managing the flows
CommunityCare pathsCommunityCare paths
Home Self-managementHome Self-
management
Hospital clinical
Pathways
Hospital clinical
Pathways
REQUIREMENT TO:•Improve connections and flows between care delivery locations.•Provide better intelligence to support better decision-making across settings.•Increase patient / family home-based management capacity.•Improve mobilisation and allocation of community resources.•Provide visibility of patient status 24/7 in home and community. •Extend reach of clinical excellence through community to home.
Care delivery locations
Service quality/risk zones
Entry/exit points
Transfers/visits/calls
Assistance/info access
Referral points
Poorly organised inter-site services coordination, compounded by under-developed community/home
capacity, and information access/exchange.
Service Innovation Needs
Connecting the dots, managing the flows
CommunityCare pathsCommunityCare paths
Home Self-managemen
t
Home Self-managemen
t
Hospital clinical
Pathways
Hospital clinical
Pathways
Care delivery locations
Manage services interaction zone
OPPORTUNITIES TO:•Locate clinically led advanced nurse practice (ANP) at heart of connection.•Coordinate / improve pathways/protocols between services.•Develop ICT-based ‘community intelligence’ information resource.•Provide clinical ‘triage’ as screening service (24/7)•Implement ICT-based ‘connectedCare’ between home, community and hospital/outpatients.•Strengthen community care and ‘service-to-home’ quality and capacity
Services Navigation Hub
ConnectedCare infrastructure, with core clinical and triage capability provides distributed platform to support pathway
integration for falls, chronic diseases, dementia.
Service Navigation Hub
Connecting the dots, for health AND well-being
CommunityCare pathsCommunityCare paths
Home Self-managementHome Self-
management
Hospital clinical
Pathways
Hospital clinical
Pathways
Managed service interaction zone
OPPORTUNITIES:•Services Navigation Hub provides rich and coherent connection to community services and resources out-side of the health service domain. •Link with age-friendly services broker, or similar (concept in trial in North Louth) can align resources to promote well-being and maintain quality of life.•Opportunity to connect ICT-based applications for Connected Care and Connected Community onto an integrated ‘cloud-based’ platform, maximising effectiveness and efficiencies.
Services Navigation Hub (ANP)
Age-Friendly community-based service network.
Safety/security. Transport.
Home repair.Isolation/social connection.
Service brokerCultáca
Extended Navigation Hub
A transformation architectureFor consideration
Empowerment:UsabilityUsefullnessChoice
Efficiency:System/service integrationClinical efficacyShifting silos and boundaries
Energy for change:MotivationAttractivenessSustainability
Standards Framework:What to fixWhat’s free to innovate
Procurement Framework:Freedom of the individualControlled by the tax-payer
Social organisation & innovation:MotivationTrust in collaborationSustainability
Implementation readiness