Reflections

In late January and early February 2018 I had the privilege of joining the Global Conference on Integrated Care (“GCIC”) in Singapore.  I am delighted to say that for me this was the most beneficial conference that I have attended since my re-connection to the aged care sector in August 2016.

Every nation represented at the Conference shared information about their significantly growing healthcare budget and rapidly ageing population. All nations have health and aged care systems that were created for a previous generation. They are not designed for the massive ageing population growth that require more and more health, social and aged care services.

As often as I remind others of the difficulties aged care providers, their workforce and clients are confronted with, I remind myself that we belong to a bigger system of health and social care provision.

Many parts of that system attract what seems to us, by comparison, to be outrageous funding.  Maintenance care only in a hospital costs approximately $1,200 per day.  A day of care in an intensive care unit costs $6,000 plus per day.  That is not to say of course that these services are not important and desperately needed.

At say $215 per day to care for people with multiple morbidities, one wonders how so many residential age care providers care so well for so many.  If a high proportion of those ICU places are occupied by people aged 75 years and over, and for whom the health prognosis is poor, would we be societally better off by offering a palliative end of life care option to futile ICU treatment?

How can we lower the cost of acute episodic ill health that arises solely from chronic conditions of ageing?  What is a better way?

In terms of integrated care, I need to say that it is not what from here I will be calling “intensive long-term care” that is so costly.  As a form of health care, the cost of intensive long-term care (high care residential aged care services) provides significant economic value to the nation.

What is expensive around care of the elderly is the interaction that many seniors have with the health and hospital system during their frail years, often during the last two years of so before advance frailty takes its course.  Working better together with health care providers – hospitals, emergency departments, paramedical services – may indeed bring further economies to our combined efforts.

There are several things that we do quite well in Australia compared to other countries.  We provide some of the best palliative care services in the world.  No matter whether it is for someone being cared for at home, or in a facility, we strive to enable a meaningfully lived life for each client, to be able to be cared for in the place of their choosing until they die.  For me, death is not the enemy.

Death reminds me though to appreciate my life while I have it. We strive to honour the client’s family as we engage with them and often coordinate a range of services around them to support them in care and in grief.

How strange it was to discover that, for example in Hong Kong, if a person dies anywhere other than in a hospital, a Coroner’s case is immediately launched.  The care provided is often as holistic as we can manage – except in death.  A client will be taken from their place of care to hospital to die.  It seems so unfortunate, but in reality, just different.

There are moves afoot in Hong Kong to effect change in this scenario.  As we know, change is often hard to achieve.  Hong Kong and China at large are experiencing a similar burgeoning of elderly population to what we are experiencing.  It is estimated that by 2025 in China there will be 80 million people aged 80 years plus.

Please just take a moment to read the previous sentence again.

That really is a staggering number of people.  To hear a Hong Kong based professor of medicine discussing the need for several intensive long-term care facilities with 1,000, or even 2,000 plus places is confronting.  Considering the sheer number of potential care recipients, a very sobering future for China.

How do we manage some of this burgeoning demand for the need for care?  Technology will almost certainly play a part.  It may not be that every facility has or needs a robot to do the work that we currently assign to a diminishing work force.

There will always be the need for high tech – high touch in our services.  Some of the tools that may assist us are already in production.  For example, toilet bowls that can conduct a urinalysis to check for blood sugar content for people with diabetes; or a smart toothbrush that is sensitive to insulin levels.

There is likely to be further development of wearable technologies that can send vital signs to health care management teams for close, yet remote monitoring of various conditions.  All enabled through the internet, and loosely labelled the internet of things (IoT).  NBN will need to be much more responsive as we take up such devices and services.  Falls monitors, weight monitors, telephony, and so on – many of these things are with us and they will likely become more an integrated part of the whole of service delivery.

Australians, however, are not lagging in many contemporary developments.  At the conference I met a delegate who described herself as a regular “farm girl” – an inventor from Australia.

She cared for both her parents as they aged and lived with dementia.  She is the “inventive brain” behind a company specialising in development of a platform that “improves the everyday lives of people with dementia through innovative technology.  The platform remodels the way patient data is stored, producing a revolutionary impact on people with dementia, health professionals, governments and society.”

I am happy to pass on the details of this Melbourne based company if you want to contact me at wbelcher@braemar.org.au.  I have no affiliation with this group and will simply provide you with contact details.

All I am suggesting is that we are all on a journey to improve care and ensure that as far as possible we provide care in relationship with others who can do the things we cannot – complementing the other – to provide more rounded care to all our clients.

Sometimes in our aged care silo we can lose sight of the bigger issues.

Nice chatting!

For my full paper – click here (PDF)

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