an uncertain age: reimagining long term care in the 21st century

An uncertain age: Reimagining long term care in the 21st century June 2013

2 © 2013 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate or bind any member firm. All rights reserved.

About the Lien Foundation

Philanthropic organization in Singapore – elderly care, water & sanitation and preschool education

■ Lead: spearhead strategic partnerships and activities to deliver practical, sustainable solutions for society’s benefit.

■ Innovate: mobilize resources, and pushes boundaries for new ways of addressing urgent needs and critical gaps.

■ Empower: enable society and individuals to operate at their maximum capacity.

■ Network: stimulate and spark high-impact idea exchange, high-intensity collaboration, and high-end value creation by leveraging on the people, private and public sectors


Project background and objectives

The objectives of this report are:

- to understand what would make a successful long-term elderly care model;

- to promote and advocate the right care of the elderly; and

- to enhance the services and facilities delivered within the aged care sector.

Background Project Objectives

People are living longer and, in some parts of the world, healthier lives. The fast ageing of populations around the world is presenting challenges for developed and developing countries and it is important that we cater for these needs.

Long term elderly care can broadly be defined as a variety of services that are offered to the elderly with a chronic illness, disability or frailty, to help them meet their needs.


Our approach

The current state of long-term care

Reimagining the future – ideas to overcome the ageing challenge

Agenda for Action – steps that can be taken by governments,

payers, providers, professionals, researchers, and users and carers

14 countries / 46 interviews

Project initiation

Secondary research

Primary research

Analysis & Write-up Validation

Canada

China

Finland

Germany

Hong Kong

Japan

Norway

Singapore

Taiwan

The Netherlands

United Kingdom

United States

Australia

France

Report Themes


Interviewee profile

United States of America (8)

Canada (3)

Singapore (4)

Australia (3)

Netherlands (3)

United Kingdom (11) Taiwan (1)

Hong Kong (2)

China (1)

Japan (5)

Norway (1)

Germany (2)

Finland (1)

Note: -1 interviewee was a UN individual – therefore had no nationality assigned


New models of integrated care and a new approach to medicine in long term care

Sustainable funding for elderly care is a critical issue

Top 3 findings

Need for a national conversation about the elderly crisis

Finding

Finding

Finding

1

2 3


The world’s population is ageing progressively, mainly due to the aging baby boomers in many countries = change in dependency ratio & increased demand for elderly LTC.

The rise and rise of the senior population

Shares of the population aged over 65 and 80 years in OECD countries, 2009–50

Source: OCED Labour Force and Demographic Database, 2010


The demand for elderly long term care

“The system of activities undertaken by informal caregivers and/or professionals to ensure that a person who is not fully capable of self care can maintain the highest

possible quality of life…”

23.922.2

19.418.2 18.2

17.6 17.5

16.1

13.913.1 12.8 12.6

12.011.3 11.1

11.3

7.812.1 6.6 6.5

5.95.1

4.0 3.7 3.6 3.2 3.2

1.1 0.9

0

5

10

15

20

25

Institutions Home

% o

f pop

ulat

ion

aged

65

year

s an

d

Institutions + HomePopulation aged 65 years and over receiving long-term care, 2009 (or nearest year)

Source: OCED Health Data, 2011 1. In the United States, data for home care recipients refer to 2007 and data for recipients in institutions refer to 2004. 2. In Austria, it is not possible to distinguish LTC recipients at home or in institutions. The data refer to people receiving an allowance for LTC, regardless of whether the care is provided at home or in institutions.


Resource challenges

Low availability of elderly

LTC services

Funding constraints

Dwindling healthcare workforce

Key supply pressures

Reimagining the future…..


Deliver person-centered care

Better ways of meeting the needs of patients and their carers including patient centered approaches etc.

■ Orient care to meet the unique needs of each individual – ensure elderly people are treated with respect and given as much autonomy and independence as possible.

■ Societal norms (what is good aging vs. bad aging)

■ End of life care ■ Personalized, negotiated care plan on

a person-to-person basis


Integrate care & rethink medical care

Redesigning medical input and changing the philosophy of medicine for elderly/ end-of-life:

Program for All Inclusive

Care for the Elderly (PACE)

■ Integrate care by bringing together various specialties of care staff (e.g. family doctors, geriatricians, OTs, physiotherapists, social workers etc)

■ Promote seamless services – common IT systems, data sharing, common care pathways and accountable care managers

■ Multidisciplinary teams = greater efficiency and better outcomes

■ Need for a different kind of specialist medicine ■ Shift from providing a ‘cure at all costs’ to an emphasis on wellbeing and happiness. ■ Values and outcomes have to be a higher priority

- Improve value by giving user control of his or her own care – direct payments

Integration


■ Get more out of communities - Provide incentives for individuals to volunteer – Time Banks - Encourage healthy retired individuals to provide care – Grand-Aides Foundation

■ Expand the range of care locations - alternatives to traditional healthcare institutions - Patient Hotels

Use the power of communities

Care setting (i.e. where people are cared for) – the options and what we think.

■ Aging in place, the balance of home vs. institutional care

■ New concepts of retirement villages - Resident-owned homes built around facilities

that offer medical care, community services, and entertainment

- Virtual villages based on a volunteer help system – Beacon Hill Village, Boston, US

- Partnerships with local non-profit organizations and reliance on informal volunteers – Community Without Walls, New Jersey, US


Invest in the formal and informal workforce

Supporting the formal workforce

■ Empower caregivers ■ Provide relevant support and training to

improve skills and emotional wellbeing

■ Provide structured career paths and consider funding under-utilized groups (e.g. retirees, housewives or neighborhood volunteers)

Supporting informal careers

■ Encourage informal carers without providing a monetary incentive. ■ Develop care plans with the carer and recipient ■ Ensure professionals recognise informal caregivers’ expertise ■ Be responsive to requests for assistance from caregivers and

/provide personal support (e.g. time-off when needed) ■ Educate and train caregivers


Embrace technology

Long-term care is currently highly labor intensive – technology can bring about significant efficiencies.

■ Information technology = real time flow of data = makes administration, record keeping and reporting more efficient

■ Remote monitoring systems = reduce level of monitoring of care required by the elderly

■ Sophisticated data analysis can enable more accurate case identification and risk assessment

■ Social robotics can help long term care patients with daily chores and provide comfort and companionship

■ The challenge is to overcome the slow adoption of technology by long term care providers


Focus on outcomes

The overriding trend in healthcare is towards value (outcomes / costs) – so LTC providers need to be incentivized accordingly.

■ Providers face scrutiny by regulators to ensure that savings are not at the expense of quality

- Need to be transparent about all their costs - Outcomes have to be closely managed

■ Introduction of personal budgets ■ Let the recipient choose how they want to spend

their money and what care they want to receive.


Develop better funding models

Sustainably funding long term care is a challenging issue

■ Countries are considering various mixes of public and private models

■ Scale of the challenge calls for more innovative approaches!

■ Citizens need to be encouraged to save more for retirement and take out specific long term care insurance policies

■ Equity release schemes


Carry out more research & Change attitudes to ageing

International Longevity Centre Global Alliance

There is a limited amount of research on policy and much less consensus about the role of government than there is in healthcare.

■ Establishment of an “observatory” ■ Discussion on what governments, payers, providers, professionals and

researchers need to do - workforce and funding issues


Agenda for Action

Governments should: Create a holistic elderly policy

Seek a sustainable funding model

Address workforce shortages with various initiatives

Regulate quality and promote transparency

Consider changing regulations to make homes and communities more age friendly and dementia-friendly.

Providers should: Integrate care to make it more

person-centred/ develop care plans for individuals

Invest in staff training and support

Embed the right organisation values through staff recruitment and appraisal

Improve the level of medical input to LTC

Embrace technology

Raise the reputation of the LTC sector and its workforce

Users and carers should: Assert their rights, demand

information and participate in planning.

Payers (national/local governments, social and private insurers) should: Encourage providers to focus on the

value they provide to the individual

Reward quality and professionalism rather than cost cutting

Incentivize integration, care planning and specialist medical input

Give more control to users and carers

Professionals should: Build the skills to deal with complex

health and social care needs

Rethink the use of medication in a way that maximises quality of life

Develop new approaches to goal oriented medicine for people in LTC. Researchers should:

Investigate new models of care delivery, technology, and other health services

Research the effectiveness of drugs for the elderly and people with multiple pathology

Produce international comparisons of developments and data


Innovative solutions

Ideas for the future

Deliver person-cantered care Integrate care Rethink medical care Look beyond institutional boundaries

towards the community Invest in the formal and informal workforce Embrace technology Focus on outcomes Develop better funding models Carry out more research Change attitudes to aging

Program for All Inclusive

Care for the Elderly (PACE)


Case studies

■ Netherlands based home care provider

organisation – Dutch Employer of the Year 2011

■ Empowering care professionals – nurses work as independent, responsible teams and are responsible for the complete process

■ 50% reduction in costs, better quality of care, higher work productivity and satisfaction

Buurtzorg

■ Started in the US, San Francisco’s Chinatown in

1970s - provides integrated care for frail and disabled older adults who require nursing home care, but are able to safely reside in a community

■ Elderly attend day health centre – receive services from a multidisciplinary care team

■ Reduce costs by delaying nursing home care/shortening hospital stays

Program for All Inclusive Care for the Elderly (PACE) ■ Founded in 1994 in the US. Currently has about

300 registered homes across US, Canada, Europe and Australia

■ Person-centred care is promoted. Intergenerational relationships with younger members of the community are encouraged – helps change attitudes on aging

■ Creates elderly care environments that enhance the lives of the elderly and caregivers, shift care out of institutions and tailor services

Eden Alternative

■ Based in Houston, US - recruits experienced and older local community members to function as nurse ‘extenders’ and provide care

■ Each member helps care for 200-250 families and attends to care recipients in their home (primary care conditions)

■ Early results indicate a fall in visits to clinics and emergency clinics of around 60-70%

Grand-Aides Foundation


Thinking about your audience

Long term elderly care is the most under examined, under serviced and ill prepared area of the healthcare systems – in virtually every country in the world.

■ What’s in the news? In the headlines? ■ Are there any stories from your country/ region that could start the conversation?

We believe this is a significant report to share with you, your clients, prospects and media.

■ Who would be the target audience in your market? ■ Are there any influential people in your country who can help promote/ advocate

the paper?


Trends in your market and potential services offerings

Some trends that are observed and repeated in different countries.

■ Health / Social care reform agenda ■ Pressure to cut costs ■ Integration ■ …

These are the services offerings that you can sell when leveraging this report:

■ State Medicaid program redesign ■ Service integration planning ■ Actuarial/costing analysis ■ IT support

Many thanks to the following individuals for their support…..

Expert panel: • Nigel Edwards – UK (Project Co-Lead) • Kathy Ostin – Australia • Keiichi Ohwari – Japan • Marc Berg – Netherlands • David Hansell – United States of America • Nancy Valley – United States of America

Research team: • Tanvi Arora • Gaurav Narang Interviewers: • Ruth Lewis • Beatrice Brooke • Andrea Cohen • Emmeline Kunst • Sachiko Wada • Noriyasu Furuya • Dominic Carrell • Anne Fitzpatrick

Thank you Nigel Edwards Director, Global Healthcare Practice United Kingdom Email: [email protected]

Dr. Loke Wai Chiong Director, Global Healthcare Practice Singapore Email: [email protected]

David Hansell Global Head, Human & Social Services COE United States Email: [email protected]

© 2013 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavour to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act on such information without appropriate professional advice after a thorough examination of the particular situation.

an uncertain age: reimagining long term care in the 21st century

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