an uncertain age: reimagining long term care in the 21st century
DESCRIPTION
The Lien Foundation commissioned KPMG international to produce “An uncertain age: Reimagining long term care in the 21st century” to inform and stimulate the global dialogue on long term elderly care.TRANSCRIPT
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
3 © 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.
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.
4 © 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.
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
5 © 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.
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
6 © 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.
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
7 © 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.
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
8 © 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.
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.
9 © 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.
Resource challenges
Low availability of elderly
LTC services
Funding constraints
Dwindling healthcare workforce
Key supply pressures
Reimagining the future…..
11 © 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.
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
12 © 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.
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
13 © 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.
■ 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
14 © 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.
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
15 © 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.
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
16 © 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.
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.
17 © 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.
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
18 © 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.
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
19 © 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.
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
20 © 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.
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)
21 © 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.
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
22 © 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.
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?
23 © 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.
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.