Demand Driven Care and Technology for Independently Living Older Persons Dr. Helianthe S.M. Kort, Associate Professor Demand Driven Care Hogeschool Utrecht, University of Professional Education

Demand Control n Demand control is a package of measures in order to enhance the authority of civilians in relation to the available supply. n Demand driven processes such as a free market system is also seen in education, day care, housing and health care.

Demand Driven Care n (Health) Care used to be supply driven only n Transition process n Bureaucratic centrally driven and planning towards n Empowerment of Quality of care and Quality of Live

Demand Driven Care n Enhancement of the position of patients and clients n Development of measures of freedom and a stimulating care structure n Implementation of an equal playing ground for care suppliers n Creation of a sufficient care supply

Context of the Transition process n Ageing of the population n Institutionalization -> Socialization n Increasing care demand n Patients -> Empowerment of Clients n Institutional related funding -> Performance related funding n More freedom of choices n Free market-basis system n Limited availability of professional carers n Application of Technology

Ageing of the population n Ageing n Growth in 55-pluss n Hazing n Potential working force decreases n Ageing in the Netherlands n Felevoland approx. 20% (65 plus) n In 2050 increase to 100% n Highst 65 plus in Europe n Belgium and Germany (16,9%) n France (16,2%) n UK (15,9%) n The Netherlands (13,6%)

Increasing care demand n Elderly deteriorating health n Diseases increases n Dementia, COPD, Diabetes mellitus, angiopathy, several Cancers n Mental disorders n Limitation in ADL n Domestic work n Mobility n Personal Care

Ageing & Coloring Disease (number of patients per 1000 persons > 65 jaar. Increase in percentage number patients in relation to 2000 Mobility diseases 42344% Coronary diseases 14049% Asthma / COPD 12548% Diabetes mellitus 9848% Dementia 9439% Psychological diseases 9344%

Ageing is not for sissy ’s! Limitation in mobility increases usually at 74 Y > n Care n Coping ability n Infrastructure n Housing n Day structure

Increasing care demand n The potential demand is expected to increase by almost 50%. n This demand almost equals the growth of the population of 65 years and over. n The potential demand for care at home increases more rapidly (53%) compared to the demand for institutional care (42%). n The type of the potential demand for care by elderly, varies from 40% - 80% for personal care and supporting care respectively

Availability of professional carers n The need for professional care givers increases every year, by 2% on average. n More than one out of ten people of the professional population work in the care- and welfare sector n of which 78% are women working part time. n Approximately 22% of the work force should be employed in the care- and welfare sector by the year 2025

Application of Technology n 93% of the elderly (2.2 mil of 65 plus) lives indepentenly n 33% of the elderly with a sever physical disorder has no appropriate house n Appliance Technology n Adaptation of houses n stair elevators n Houses without a threshold n 0-floor houses n personal alarming

Law & Legislation n Eigen ziektekostenverzekering n Ziekenfonds Wet (regeling Extramuralisering) n AWBZ n WMO

Nieuwe regels betreffende maatschappelijke ondersteuning (WMO) n Wvg De Wvg gaat zowel over de verstrekking van individuele hulpmiddelen als over de woningaanpassingen met name door het laatste punt zijn gemeenten in budgettaire problemen gekomen.Het is de vrees van de leden van de VVD-fractie dat gemeenten onder het Wmo-regime meer mogelijkheden hebben om zich aan deze dure aanpassingen te onttrek- ken. Blijft het ook in de Wmo het uitgangspunt dat mensen met een beper- king zelfstandig bijvoorbeeld hun maaltijd kunnen bereiden of hun slaap- kamer moeten kunnen bereiken?M.a.w.blijven mensen die onderdeel zijn van een leefeenheid waar eventueel een partner of kinderen deel van uitmaken,een aanspraak houden op een aanpassing in de keuken of een traplift zonder dat hierbij gebruik gemaakt wordt van de term «gebruike- lijke zorg »? Tweede Kamer,vergaderjaar 2005 –2006,30 131,nr.32

Smart Homes related with bio- sensors n Health Smart Homes n Permit return at home n Stay at home n Generic -> specific sensors n Human daily activities (telemonitoring) n Physiological processes (cardiac / respiratory rhythm) n Specific disorder sensors -> alarm triggering n Asthma n Angiopathy n Mental disorders

Tele-healthcare n Telemonitoring n Telecare n Telemedicine n Not always cost effective n patients experience an improvement of the quality of care n Teledermatology is more cost effective when patients are living remotely. n Teledermatology has an effect on long waiting lists, impact on job satisfaction, cost of return visits and less time off work n Teleconsultation n Videolinked support n Informal carers (Alzheimer’s disease) n Routine procedure for welcoming and conducting the assessment

Stefanov, D.H., Bien, Z., and Bang, W.-C. (2004). The Smart House for Older Persons and Persons With Physical Disabilities: Structure, Technology Arrangements, and Perspectives. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 12(2),

Health technology developments in relations to patients reached Genomics Medical devices ICT Logistic proces Intelligent solutions High tech / Low tech Cure / Care Well being-> health care, mobility, leisure, work Diagnostics / Live extension Hereditary diagnostics / Multifactorial health problems

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