Ageing and place

1. Ageing and place Considerations on the implementation of ICT for health and wellbeing in Ireland Rodd Bond mriai Netwell Centre, Dundalk Institute of Technology Home Sweet Home Workshop Barcelona - 17th Jan 2013

2. Individual & family’s Quality of Life (QOL) Public / private & voluntary Quality of Service (QOS) Home, neighbourhood & city Quality of Environment (QOE) Netwell/Casala …… • The Netwell Centre and CASALA collaborate with governmental agencies, academic institutes and industry to: • develop new ideas that enhance the quality of life and well-being of older people and those who care for them • Through more integrated community-oriented services, more sustainable home and neighbourhood design, and more affective and age-friendly technologies.

3. The Issues – national cuts Demographic pressure Staff reductions Reducing costs Improving outcomes

4. The Issues – local cuts Health spending cuts 36 Bed closures Reduction in opening hours 70,000 Home help hours

5. Policy areas National & European National Agenda EU Agenda Smart, Sustainable & Inclusive Growth Demographic change EIP: AHA, Smart Cities Regional development & competitiveness – smart specialisation Horizon2020-R&D Social innovation • Health Strategy • Positive Ageing Strategy • Carers’ Strategy • Dementia Strategy • Public Sector Reform • Local Government Reform • Industrial Development • R&D Weak funding ! Capacity ! Austerity ! Addressing weak implementation! Fragmentation ! Greater dependency on collaboration with the community & voluntary sector

6. Connect 1st Principle - Citizen centric Person at the heart Person Family Community/Voluntary Prevention & intervention Active Ageing Public services Private services Care & Cure 1. Cross sectoral alignments 2. Pathway integration

7. Movements Touch points The Age-Friendly Cities Movement Health Services Reform Stakeholder collaboration User/citizen engagement Social innovation Connectivity / ICT Dissolving boundaries

8. Movements Health Service Reform Clinical quality Resource Re-configuration Extend organisational edge for self-management Front-line Financial balance Equitable access

9. Age-friendly cities / counties • Connection: • Rural transport & urban mobility • Confidence: • Sense of safety & security • Empowerment: • Better access to better information • Alignment & Convergence: • Health, housing and care • Shareable places for all: • recognise frailty • Lifecourse: • Inter-generational solidarity • Energy for change: • Older people as a resource • Model for age-friendly city development • Driven at a local government/community integration level • Leadership of individual county managers • National oversight and commitments • Buildings and outdoor spaces • Housing • Transport • Respect and inclusion • Social participation • Civic participation/employment • Information and communication • Community and health services

10. HOUSING Energy Effic. Indoor Temp/ (+) ThermalComf. (-) CVD Risk (-) Blood P. Fuel Pov. (-) Stress Financial security

11. EDUCATION Curriculum Curriculum Alcohol (+) Diet Nutr. (-) Obesity Setting Setting (-) CVD Risk (-) Cholest. (+) Exercise (-) Blood P. Socialisati. Socialisati. Smoking

12. SECURITY Disorder Socio-Dem Char. (-) Obesity (-) CVD Risk (-) Cholest. Walking Neighbour. Disadvant. (+) Exercise (-) Blood P. Fear (-) Stress

13. ENVIRONM. (+) Diet Nutr. Transport mobility (-) Obesity Built Envir. Healthy Urban Plan (+) Social (-) CVD Risk (-) Cholest. Walking (+) Exercise (-) Blood P. Natural Envir. (+) Air Qual.

14. ECONOMIC Sociio Ec. Equlity Social Support Area based Init. Economic Dev. Strategy Working Condit. Economic Growth Municipal Investment Income Employment

15. HOUSING EDUCATION SECURITY ENVIRONM. ECONOMIC Energy Effic. Energy Effic. Curriculum Curriculum Curriculum Indoor Temp/ Indoor Temp/ Sociio Ec. Equlity Sociio Ec. Equlity Disorder Disorder Social Support Social Support (+) ThermallComf. (+) ThermalComf. Socio-Dem Char. Socio-Dem Char. Alcohol Alcohol Area based Init. Area based Init. (+) Diet Nutr. (+) Diet Nutr. (+) Diet Nutr. Transport mobility Transport mobility (-) Obesity (-) Obesity (-) Obesity (-) Obesity Economic Dev. Strategy Economic Dev. Strategy Built Envir. Built Envir. Healthy Urban Plan Healthy Urban Plan (+) Social (+) Social Working Condit. Working Condit. Setting Setting Setting (-) CVD Risk (-) CVD Risk (-) CVD Risk (-) CVD Risk (-) CVD Risk (-) Cholest. (-) Cholest. (-) Cholest. (-) Cholest. Walking Walking Walking Economic Growth Economic Growth Neighbour. Disadvant. Neighbour. Disadvant. (+) Exercise (+) Exercise (+) Exercise (+) Exercise (-) Blood P. (-) Blood P. (-) Blood P. (-) Blood P. (-) Blood P. Natural Envir. Natural Envir. Municipal Investment Municipal Investment Income Income Fear Fear (+) Air Qual. (+) Air Qual. Socialisati. Socialisati. Socialisati. Fuel Pov. Fuel Pov. (-) Stress (-) Stress (-) Stress Employment Employment Smoking Smoking Financial security Financial security

16. Service Innovation Needs Connecting the dots, managing the flows • REQUIREMENT TO: • Improve connections and flows between care delivery locations. • Provide better intelligence to support better decision-making across settings. • Increase patient / family home-based management capacity. • Improve mobilisation and allocation of community resources. • Provide visibility of patient status 24/7 in home and community. • Extend reach of clinical excellence through community to home. Care delivery locations Service quality/risk zones Hospital clinical Pathways Entry/exit points Transfers/visits/calls Assistance/info access Referral points Community Care paths Home Self-management Poorly organised inter-site services coordination, compounded by under-developed community/home capacity, and information access/exchange.

17. Service Navigation Hub Connecting the dots, managing the flows Hospital clinical Pathways Care delivery locations • OPPORTUNITIES TO: • Locate clinically led advanced nurse practice (ANP) at heart of connection. • Coordinate / improve pathways/protocols between services. • Develop ICT-based ‘community intelligence’ information resource. • Provide clinical ‘triage’ as screening service (24/7) • Implement ICT-based ‘connectedCare’ between home, community and hospital/outpatients. • Strengthen community care and ‘service-to-home’ quality and capacity Manage services interaction zone Services Navigation Hub Community Care paths Home Self-management ConnectedCare infrastructure, with core clinical and triage capability provides distributed platform to support pathway integration for falls, chronic diseases, dementia.

18. Extended Navigation Hub Connecting the dots, for health AND well-being Hospital clinical Pathways • OPPORTUNITIES: • Services Navigation Hub provides rich and coherent connection to community services and resources out-side of the health service domain. • Link with age-friendly services broker, or similar (concept in trial in North Louth) can align resources to promote well-being and maintain quality of life. • Opportunity to connect ICT-based applications for Connected Care and Connected Community onto an integrated ‘cloud-based’ platform, maximising effectiveness and efficiencies. Managed service interaction zone Services Navigation Hub (ANP) Community Care paths Home Self-management Service broker Cultáca Safety/ security. Transport. Isolation/ social connection. Home repair. Age-Friendly community-based service network.

19. For consideration A transformation architecture Empowerment: Usability Usefullness Choice Efficiency: System/service integration Clinical efficacy Shifting silos and boundaries Energy for change: Motivation Attractiveness Sustainability Implementation readiness Standards Framework: What to fix What’s free to innovate Procurement Framework: Freedom of the individual Controlled by the tax-payer Social organisation & innovation: Motivation Trust in collaboration Sustainability