Modern Aging Singapore kicked off in the middle of August. So far, the program has seen active participation and support from aspiring entrepreneurs. About three hundred students, health practitioners, researchers, and members of the public attended the Kickoff Workshop held at the NUS I Cube Building Auditorium on the morning of August 15.
Attendees were treated to four presentations from experts in aging and business: Overview of Aging by Prof. Angelique Chan of Duke-NUS Graduate Medical School, Healthcare and Business by Dr. Jeremy Lim of Oliver Wyman, Home and Center Based Care by Dr. Ng Wai Chong of the Tsao Foundation, and Product Design for Seniors by Hunn Wai of design firm Lanzavecchia + Wai.
Prof. Chan highlighted some key trends and statistics on aging in Singapore. One surprising point was the high prevalence of social isolation among seniors here. This finding spurred aspiring entrepreneurs to think of novel solutions to address this trend.
Dr. Lim went on to outline the aging sector in terms of business potential. One suprising finding, according to theNational Center for Policy Analysis, is the average net worth in 2010 was 848,000 USD for sixty five to seventy four year olds and nearly seven hundred thousand dollars for those above seventy five. These figures encouraged aspiring entrepreneurs to enter the aging sector.
Dr. Ng discussed the current status of home and center based care in Singapore. He highlighted specific needs in these care settings frequently used by seniors. This discussion allowed aspiring entrepreneurs to hone in on key areas of need and address these pain points. For example, some challenges in these settings include the quick and painless transferring of patients from bed to chair and vice versa, and increasing the time health practitioners can spend with seniors.
Mr. Wai rounded off the presentations with insights from product and design perspectives. He introduced examples of good design for seniors, such as mixed use canes and walkers, or stylish back braces. This presentation especially inspired aspiring entrepreneurs to consider seniors’ lifestyles and tastes when introducing new product ideas.
In addition to expert presentations, attendees also heard two senior role models share their life experiences and lessons. Younger members of the audience seemed glad to hear the wise advice dispensed by the seniors. The kickoff event concluded with a networking lunch. Participants became so engrossed in conversations around aging that they lingered past the scheduled end time.
Currently, Modern Aging Singapore has progressed to the business curriculum and selection phase. The top twenty teams have been selected and paired with industry mentors to hone their business ideas. The twenty teams will soon be pitching at the semifinals judging event for the top six spots. Meanwhile, all participants of Modern Aging Singapore are able to access the same business and aging curriculum on the Modern Aging Online Learning Portal to continue learning and improving their business ideas. If you would like to access the Portal, please write an email request to firstname.lastname@example.org.
Find out more about Modern Aging, at www.modernaging.org.
US House of Representatives Votes to Repeal Medicare Sustainable Growth Rate and Strengthen Medicare Access
We at ACCESS Health have been watching the news closely for the last two weeks. The issue of interest was the vote by the United States (US) House of Representatives on March 26 to repeal the Medicare sustainable growth rate formula and to “strengthen Medicare access by improving physician payments and making other improvements.” The bill can be viewed here.
This event is noteworthy in a few ways. One is that the 392 to 37 vote reveals overwhelming bipartisan support for these changes. Another is that, if passed by both houses of Congress, the bill would change the US healthcare payment system significantly. The bill still needs to be passed by the Senate.
If passed, how will the bill affect healthcare in the US? First, the bill repeals the sustainable growth rate formula used by Medicare. The sustainable growth rate formula pegs provider reimbursements to economic growth, as measured by gross domestic product (GDP). In place of the sustainable growth rate formula, the bill proposes value based payment models such as accountable care organizations and bundled payment. Accountable care organizations link doctors, hospitals, and other health professionals together to develop tailored care plans for Medicare patients. These care plans encompass the entire care process, matching the appropriate service to patients’ needs and reducing duplication of efforts. The bundled payment system reimburses care providers based on expected costs for specific clinical issues. This prevents unexpectedly high costs for patients.
Presently, the US healthcare system uses a fee for service model to pay providers. This means providers are paid for each individual service or operation, regardless of necessity or efficacy. As described in Forbes, “[Fee for service] actually rewards providers financially when patients suffer complications or infections, and pays them more if [providers] order unnecessary tests or procedures.”
Changing this system would remove incentives for healthcare providers to push large numbers of services on patients. Replacing fee for service with value based payment models could improve patient outcomes while reducing costs.
In the future, the high percentage of GDP spent on healthcare in the US may fall. According to World Bank data, the United States spent nearly eighteen percent of its GDP on healthcare in 2012, the highest in the world. GDP savings on healthcare would allow higher spending in other areas, such as education.
However, it is still too early to tell whether the bill will pass the Senate. In addition, there are still many challenges to the change. Many healthcare providers still cling to fees for services models of payment. It is also challenging to define key performance values for providers. Will providers aim to reduce readmission rates or improve life expectancies of patients? At this point, performance values are not standardized. Nevertheless, the strong bipartisan support for the bill shows a consensus that the existing sustainable growth rate model is undesirable.
This movement represents a move toward a capitation payment system, which pays providers a set amount for each patient, regardless of service type. Capitation systems are used by countries like Italy, the United Kingdom, and Denmark. In addition to the US, fee for service is used in countries like Japan, Germany, and Canada.
Interestingly, China has used the fee for service system since the 1980s. China has experienced healthcare cost increases, poor quality, and a questioning of medical ethics. These factors have led to experimental healthcare reforms, since the 2000s. City and local governments were encouraged by the central government to redesign the healthcare system, with wellbeing of patients as a main goal. China tried bundled payment systems, with some success. Jining saw a thirty three percent reduction in expenditure, while Shanghai saw a seven to twelve percent reduction in cost per outpatient visit. However, these initial results are not conclusive of the superiority of a capitation system. China continues to experiment with and review healthcare reforms.
If the US moves forward with the repeal of the sustained growth rate for Medicare, other countries facing challenges with fee for service healthcare models may follow suit. The ripples of this bill are potentially larger than domestic US healthcare policy. What do you think of these policy developments? Tell us your thoughts by leaving a comment.
ACCESS Health studies good examples of elder care in Sweden. In a series of group interviews, the Swedish team of ACCESS Health meets with a group of senior citizens to understand their needs. In this interview, the participants discuss technology, share their views on Swedish healthcare, and tell us about their experiences as informal caregivers. When they learned about the work of ACCESS Health, the participants volunteered for the focus group. The focus group participants live in the city of Eskilstuna, one hour southwest of Stockholm.
The blog post of this week is an extract from a group interview conducted on December 31, 2014 with Gudrun Bergström, eighty six, Gujje Byström, eighty nine, Inga Brehmer, eighty eight, and Ingrid Svahn, eighty five.
This is an insightful and fun read! Enjoy!
Inga Bremer (IB): My name is Inga Bremer. I am eighty eight years old. I am interested in technology. I own an iPad. I own a Doro telephone. [Doro is a company that developed a simplified mobile telephone for older users.] My Doro is easy to use. My Doro telephone is not a smartphone. Dora does develop smartphones for older consumers right now. I also own a laptop. I own other technical devices at home, such as a dishwasher and a washing machine. I also have a small automatic vacuum cleaner so that I do not need to vacuum constantly. I have three large flat screen televisions with over fifty channels. I would call myself mildly interested in technology.
Gudrun Bergström (GB): My name is Gudrun Bergström. I am eighty six years old. I love technology. I am handicapped. I have poor eyesight. Technical solutions help me live with my sight impairment. I do not own a smartphone. I own a Doro telephone.
I have one of the newest stationary computers that you can buy. I use a magnifying software program that helps me increase the size of the text of the documents on my computer. I own an external hardware product. This hardware product helps me to magnify texts and images so that I can read and see the images better. This program is called Zoom Text.
I wear a watch that reads the time for me out loud. That is a great device. I have hearing aids. I also have three televisions. I use my three televisions. I have connected my television in the kitchen with an external hard drive so that I can record programs and store them.
Sofia Widen (SW): Do you record a lot of television programs?
GB: Yes. It allows me to watch them when I want to watch the programs. It took some time to figure out how to record programs. Learning is a gradual process.
I buy technology products. The booklet with instructions is written in a small text. This is problematic. It is difficult for older consumers to read small text. I can read instructions with my magnifying program. My dream is that doctors will find a way to operate a new sight nerve into my eyes so that I regain my sight. We are not there yet.
SW: Do you use your computer to browse websites?
GB: I browse a lot of different websites. I disapprove of some things that people write on Facebook.
SW: Do you have a Facebook account?
GB: Of course. I am on Facebook.
SW: Are you active on other social media sites?
GB: No. I am not interested in blogging or in tweeting. I use Skype. I Skype with my family. I have a wireless internet connection in my apartment.
IB: We should have spoken before you, Gudrun. You have so many devices.
GB: I love technology. My husband was not interested in technology. I installed devices at home. I learn about new products. I want to buy them. More people my age ought to take an interest in technology. Technology can help the elderly.
Ingrid Svahn (IS): Technology is in your nature. Either, you understand technology or you do not.
GB: I disagree. Look at the young who adopt technology. Are they born with an ability to absorb technology quickly? I do not think so. The young set aside time to learn how to use the technology.
IS: My name is Ingrid Svahn. I just turned eighty five. My husband knew everything about technology. I never needed to learn. My husband passed away a few years ago. I use modern technology. I am not interested in technology. I had a computer. I threw it out when it crashed.
SW: What did you use your computer for?
IS: I served on the board of an organization. I used my computer to type out the minutes from our board meetings. I have a smartphone. I use my smartphone sometimes.
SW: How do use your smartphone?
IS: I play games. I like Alphabet and Scrabble. I will say, though, that like other retirees, I do not have time to play all these games. Many retired people I know say they are busy. I also feel that I am busy all the time. I also own televisions. I use a dishwasher and a vacuum cleaner.
I use a pen for my touchscreen smartphone. I do not have Wi-Fi. I access the internet through the mobile network. Other family members discuss what kind of technology I need. They discuss whether I should install Wi-Fi or not. I do not know how the discussion will end. I might buy a tablet.
GB: I recommend a tablet. Tablets are great. You can carry it around. You can carry a mobile phone of course. I would not compare the two products. A tablet is helpful for my reduced sight. I prefer a larger tablet.
Gujje Byström (GBO): I am eighty nine years old. I am not interested in technology. I own one television. I watch eleven channels. I dislike watching television during the day. I record my programs. I watch them in the evening.
From the left, Inga Brehmer with her Doro telephone and her tablet. In the middle, Gudrun Bergström, with her Doro telephone and her tablet. To the right, Ingrid Svahn with her smartphone.
GBO: I use hearing aids. I use a walker. The walker helps me when I shop. I can carry a lot of bags. I hang them on my walker. People pestered me to get a walker. I think it is wise to wait until you really need a walker before getting one. You become dependent on your walker. I could not manage to carry my groceries without my walker.
I prefer to use a cane. I have a beautiful cane. I like my cane. I have had hip and knee surgery. After my surgery I decided to get a cane. There are flowers on my cane.
IB: I have a cane. My doctor prescribed the cane, so I obtained it for free. We buy technology such as canes and walkers. We buy them because we want nicer versions. In Sweden, you obtain technical aids from your doctor or from your municipal care organization. The devices are almost free or charge. You pay up to a fixed sum every year. This is a low sum. If you pay the fixed sum, you can obtain all devices that you need.
GB: We can discuss if you always obtain all the devices and all the aids that you need. I have a friend who requested two walkers. She was refused those two walkers. She wanted one robust walker for outside use in the snow. She wanted a smaller walker for use inside her apartment.
I returned the walker I was given for free. I bought my own walker. Look at my walker. I can lift it. It is light. [Gudrun demonstrates. She brings out her walker to the focus group.]
GBO: Those walkers are expensive. You made an investment.
GB: I can carry up to seven bottles of wine with this walker!
SW: Can you use the walker with thin wheels outside in the snow?
GB: If it is that snowy I do not go outside. There is no reason for me to leave the house when I cannot walk on the streets. Most Swedish cities are not accessible to the elderly in the winter. Too much snow and ice on the pavement prevents the elderly from leaving their houses.
Södermanland County Council hands out two types of walkers: one with large wheels and one with smaller wheels. Rules vary from county to county because regional governments are autonomous. The number of aids that you can obtain from each county varies.
GBO: The design of certain walkers can hurt your shoulders. I experience pain in my shoulders because of the way I walk and what I carry. I never experienced pain in my shoulders before. I have experienced pain in all other parts of my body before. I never suffered pain in my shoulders before.
You will soon be able to read the entire interview, posted on the ACCESS Health website here.
This blog post introduces Care Company TioHundra in Norrtälje, Sweden. This is a unique model of integrated care in Europe. I have had the opportunity to interview Peter Graf, Chief Operating Officer of TioHundra. Peter Graf talks openly about the challenges and the many opportunities that TioHundra faces. I have also had the opportunity to interview members of the staff and managers throughout the organization. Through these interviews, I have gained an understanding of the different parts of the company. I will tell you about my impressions of TioHundra in a series of blog posts. You can access the full interviews and all relevant background information from this case study on the ACCESS Health website.
An older person with multiple diseases often requires care from several healthcare and care providers. This elderly patient may travel to a local hospital for treatment. It is not uncommon that up to sixty people from various care organizations are involved in the care of an older individual with complex care needs. Patients with complex care needs require the services of both the county healthcare providers and the local municipal care organizations. As individuals in Sweden age, and as more people live with multiple diseases and have complex care needs, counties and municipalities realize the need for greater care coordination. Care coordination to meet the needs of the elderly is one of the greatest challenges in Swedish healthcare, witnessed by the large effort of the previous center right coalition government to improve care coordination in the program “The Most Ill Elderly” from 2010 to 2014. The previous government allocated over four billion Swedish kronor to improve the coordination of care for the most ill elderly. TioHundra shows that their model of integrated care already works well. During the program The Most Ill Elderly, TioHundra received funding based on the results they displayed in their work for the most elderly ill. These results included a reduction in unsuitable medication for the elderly and shorter wait times in the emergency room, among other areas.
Elsewhere in Sweden, regional governments manage the healthcare provision while local governments provide homecare and social care. Well defined areas of responsibility ensure that each provider in healthcare and in social care can focus on a range of services. In theory, the specialization of each level of government ensures that citizens obtain the healthcare and homecare they need. In practice, the division of responsibilities causes delays in service delivery, and at times, it compromises the quality of care. Regional and local governments use different communications systems, have distinctive work cultures, and use individual terminologies. Older frail patients, among other groups, suffer when healthcare providers fail to communicate effectively across organizations. TioHundra overcomes many problems of care coordination. Instead of coordinating care across organizations, TioHundra merged multiple care providers, now operating as one large healthcare and care system. This merger entails one of the largest regional reforms of Swedish healthcare since the Nobel Reform in 1992.
Care Company TioHundra is a public healthcare company that provides integrated care in Norrtälje, a city one hour north of Stockholm in Sweden. TioHundra operates an emergency hospital, six primary healthcare clinics, and a home healthcare organization for patients who are unable to travel to obtain care. It also manages social care and homecare organizations. The company runs nine nursing homes and it has 3,500 employees, including healthcare professionals and administrative staff.
To improve the quality of healthcare and to overcome the care coordination problems of regional and local administrations, Norrtälje and the Stockholm County Council established TioHundra in 2006.
The guiding philosophy of TioHundra is to construct an integrated healthcare system. The objective is to be the leader in integrated care in Sweden, and to be the number one choice of care provider in Norrtälje. The management approach centers on constant improvements. Managers and employees at all levels of the company identify areas for improvement, suggest new routines, and implement changes. The idea is to constantly improve service delivery and employee satisfaction.
Improved Care, Lower Cost
The ability to turn around negative operating results of previous years into a positive net result helped to convince politicians in the region that TioHundra improves the quality of care while lowering the delivery costs. Results from the employee survey show that the company employs a more satisfied workforce in 2014 than in 2013.
TioHundra manages to overcome certain problems of care coordination that persist in other regions and in other municipalities. Formal and informal channels of communication improve the transfer of information between different departments. Patient data is shared throughout the organization with the help of read only functions in patient journals. Weekly meetings of the management team foster an atmosphere of cooperation. Where disagreement occurs, the meetings serve as an arena for constructive debate.
TioHundra obtains one pool of financial resources from municipal and county taxes. Elsewhere, counties raise taxes for healthcare while municipalities raise separate taxes for social care. Budget silos prevent counties and municipalities to coordinate care in other parts of Sweden. One level of government is sometimes reluctant to deliver a service it considers to be the responsibility of the other level of government. The organizational structure of TioHundra allows this problem to be overcome through a lateral integration of caregivers from the county and the municipality.
In summary, TioHundra is a unique healthcare company. There are no other companies like TioHundra in Sweden. Few similar care organizations exist elsewhere in the Nordic countries. TioHundra reported a balanced budge for the first time in 2014. It also marked a year where management recorded improvements in employee satisfaction. TioHundra delivers healthcare of high quality at relatively low costs. The company has reduced the number of medications per older patient, reduced the prescription of unsuitable medications for the elderly, and it has shortened emergency room wait times for this patient group.
It remains to be seen how the integrated care model of TioHundra evolves. A transition in 2015 away from a focus on balancing the budget, towards operational and organizational changes is already noticeable. This is a young company with an eager management team. If the quality of care improves dramatically, and if the costs of healthcare can be contained in Norrtälje, other counties and municipalities may look into adopting the model of TioHundra.
 De mest sjuka äldre
Ideas sometimes seem so simple and obviously great, so you ask yourself ”Why has nobody come up with that before?!”
I came across the innovative Speaking Exchange project, which is about lightening up the lives of elderly, while at the same time giving Brazilian students the opportunity to practice their English skills. Reports about this case seem to go viral on the web these very days (see links below).
I was so surprised and fascinated when I watched this clip about the Speaking Exchange:
The man shows the boy an old photo. “Is this your dad?” the boy asks. “No, It’s me and my wife when we were young”, he answers. “Oh you were good-looking when you were young”, the boy says – pause – “and you are still good-looking!”.
“I look like I’m only 25”, another man says. He and the boy a are laughing, “but I’m 88”. The two are having a nice conversation. In the end, they share a big, virtual hug.
The school uses its own digital tool for video chatting where conversations are recorded and uploaded privately for teachers to evaluate the talk language-wise.
But there is much more to this than just the language…
It’s fun and warms my heart to listen to their conversations about all the World and his brother.
Our most loyal readers on Silverevolution may remember the program Modern Aging that we wrote about in April (see the post HERE). This innovation program for young entrepreneurs with ideas for the elderly kicked off in August this year. A group of 7 entrepreneurs have been selected based on the potential of their improvement idea as well as their motivation to lead the way in transforming the elderly care sector. We are currently in the act of developing their ideas with the help of mentors and coaches and in close discussion with the elderly themselves. During the next couple of weeks the participants will blog about their ideas on the Forum for Social Innovation Sweden and we will post them here on Silverevolution as well.
First in line; introducing himself and his idea is Victor Nordlind. This is his story:
One may ask why a person who is attending one of the world’s top hotel schools would want to pursue a career in developing and improving the elderly care. Most people expected me to walk in my father’s footsteps in the restaurant industry, rather than radically changing field to Elderly care.
But as I was required to carry out a feasibility study about an existing retirement home during my first two years at Ecole Hôtelière de Lausanne (EHL), I was given the opportunity to see the true potential within this industry. It encouraged me to apply for an internship within elderly care, which I am currently pursuing within Strategy and Business Development at Ambea Sverige, whose affiliation is Carema Care. For me, elderly care is an industry where innovation is necessary in order to provide the correct quality of life, which in my opinion is the meaning of hospitality.
When I first came across the Modern Aging program, I did not have a specific idea for elderly in mind. When developing the idea, it was equally important to link the project back to my studies, as to work with something that may truly make a difference within the elderly sector. I decided to contact a friend who has several years of experience within elderly care, and who is currently working in a nursing home here in Sweden. I was convinced that my determination combined with her extensive experience would bring something innovative out of the meeting.
As expected, we had a very interesting discussion, which brought several ideas to the table. Most of them were linked to the use of more technology, which is a frequently debated topic when talking about improvements within elderly care. The trend of using technology to improve efficiency is relatively new in the industry while it has been an essential part of the hotel and restaurant industry for years. More and more apps and other technical devices are being developed to simplify everyday activities for the elderly.
However, one question that came up during the meeting was “how can we use technology to better involve the caregivers within elderly care?” These professionals have valuable knowledge and experience, which they should be able to share easily. With today’s progression of social media and online forums, a place for caregivers and other health care professionals to meet online should be developed. There, they may share ideas, knowledge and ask questions to one another over space and time. This will not only simplify and streamline the daily work, but it will also improve the quality of care in nursing homes in the long run. A forum like this needs to be strictly confidential with only registered users permitted access. The idea is also that this platform shall be the forum that compiles and disseminates knowledge of the latest advances in medical, social and technological solutions for the elderly.
My current internship at Ambea combined with the Modern Aging program has helped me to better understand the current market as well as the future prospects of elderly care in Sweden. To date, Modern Aging has hosted several seminars and workshops carried out by inspiring guest speakers from various fields, such as young entrepreneurs, lecturers from top universities, and professionals from the public health care sector. With this promising start, I am curious and eager to find out where the program is going to take us.
EU-funded unique international project aimed at providing safer and healthier aging is led by researchers at Örebro University (Sweden) in collaboration with twelve partners from six countries Sweden, Italy, Spain, Portugal, UK and Slovenia. The unique feature of the project is that it will provide seniors with smart home system combining both long-term health evaluation and caregiver-user interaction.
The project is called “Giraff” and received its name after remotely controlled mobile robot “Giraff” equipped with a display and loudspeaker. This robot lays in the heart of the smart home system in combination with continuous monitoring through a network of sensors.
Multiple sensors are installed in the apartment and can measure blood pressure, body temperature and register movements. Data from the sensors will enable to identify if someone takes a sudden fall or doesn’t move for unusually long time, analyze sleeping pattern and level of physical activity, which can be of particular importance for physiotherapists. All the data collected from sensors are analyzed by an intelligent system, which is able to quickly alert the caregiver if something goes wrong and to conduct long-term health assessment of the seniors, thus giving caregivers a tool to adapt care plan to guarantee better quality of life.
Robot “Giraff” is designed for conducting virtual visits based on users need or on caregiver’s and family member’s intention to talk to the senior about his/her health measurements. “Giraff” can move autonomously around the apartment, find where senior is located or follow the senior around the apartment during “virtual” physician visit. In future, it will be senior’s decision on whether to use “Giraff” to have a virtual meeting with caregiver or make a journey to the healthcare center instead.
When it comes to privacy of health data, it will be only user who can allow access to health information for concerned family members or other caregivers. This will contribute to creating a user-friendly environment, where seniors will understand that they can receive an opportunity to improve their quality of life while feeling secure about privacy of their data.
The project has come to a testing phase in 15 real homes in Sweden, Italy and Spain. Last news tells about system installation in the homes of elderly women living alone in Malaga (Spain) and in Örebro (Sweden).
It is inspiring to see how modern digital technology can improve quality of life for elderly people! Stay tuned for future blog posts on digital technology for elderly care.
Picture taken from: