Non hospital based care systems – according to the WHO , refers to the provision necessary health care using technology and methods that are scientifically correct, practical, and acceptable to individuals, their families and surrounding society through their participation at an affordable cost for every stage of development to promote self-reliance and self-determination (WHO, 2016).
In Australia, non-hospital based care is defined as the universally accessible, socially appropriate care provided at the first level by a well-trained multidisciplinary workforce. In addition, this care must be scientifically acceptable and supported by integrated reliable systems that gives priority to the most needs focused on health inequalities. Primary care is reliant on community participation and individual self-reliance in collaboration with other sectors to promote public health (APHCRI, 2006).
Non hospital based health care systems form a big part of a country’s health care system with a direct contribution to social economic development. This kind of health care system ensures accessibility of national health resources and offers a basis of a continuing health care process where by an individual, his family and the community have these services brought closer to their homes and work places (Esterman, and Ben-Tovim, 2002).
Integrated Complex Care for Old people Program is a non-hospital based care system that offers clinical support like and care coordination among older people who have been identified to have complex care needs arising from multiple chronic conditions making them frequent presenters in hospitals (Warren, 2012).
The ICCE program is a bound by three objectives;
The program is based on a multi-disciplinary approach based on integrated care where a clinical services model is based on improving care for individual clients as opposed to the normal structured models whereby pre-determined designs exist and are applied.
c). Program Mission
ICCE’s mission is to provide a health care system whose focus is on the physical and psychological abilities of people advanced in age as opposed to focusing on single faceted management of specific diseases in each individual.
Advancement in age tends to come with multiple chronic and complex conditions, with some occurring concurrently in one individual. With old age, physical, sensory and cognitive impairments are more prevalent. In some cases, complex health state such as frailty and even urinary inconsistence are experienced as a result of age related chronic and complex conditions (Osborn et. al, 2014).
A study by (Anderson, 2013) reveals that about half of the US population aged above 75 years have suffered three or more conditions that are chronic. Additionally, the population aged 85 and are to suffer from multiple functional impairment six times more than that ageed between the ages of 65 to 69.
In the recent past, science and new discoveries have resulted in increased survival rate and life expectancy after experiences of medical conditions such cancer and heart disease. This is also experienced given the economic cooperation and development, in developed countries. The effect of this success is that there is are more people living longer lives but chronic conditions that need care and management in the advanced stages of life (Coyte et.al, 2008).
Additionally, there is an increased number of old people living alone as their children grow up and move to other geographical locations seeking job opportunities. These trends have given rise to an ever increasing pollution of old people in need of personal, and medical care services among the older generation. (Coyte et. al, 2008).
Normally, social care services offered by family members or, community care givers. However, given that these social needs are combined with clinical needs, informal care givers do not meet the needs of the patient fully hence older people become frequent presenters in hospital. Provision of primary care services for the older generation is however a complex project as the presence of multiple chronic illnesses in individuals calls for a need to coordinate multiple health workers drawn from different sectors to serve one individual. In countries with adequate availability of health providers, this is possible but the eventual result is disconnect between clinical management, the patient’s setting and the type of care provided.
A survey carried out over two years in 11 developed countries revealed that older adults in need of special care reported up to 41% problems related to care coordination (McIntyre, 2004). Given such circumstances, system of health care therefore fails in meeting the needs of the older generation thereby results in extra costs being incurred both by the individuals and the health care system (Nolte, 2014).
It goes without saying that there is need to serve this growing population that needs both types of services. The first and most effective intuition is to come up with an integrated system of health and social care for people advanced in age and with complex needs.
Integrated care services for people who are advanced in age calls for an overhaul of the normal design of health care systems to provide care services that are oriented and custom based on the needs of older people. As people age, they may get to a point where they are unable to perform daily basic tasks and need assistance to do so. This stage of life is care dependent and mostly combined with chronic disease and multiple conditions.
The Integrated Complex Care for the elderly (ICCE) provides medical support such as nursing and care coordination for old people with multiple and complex health care needs in the society at every intrinsic capacity level. WHO defined intrinsic capacity as the wholesome consideration of an individuals’ psychological mental and physical capabilities (WHO, 2016).
The ICCE is therefore designed to serve individuals with a remarkable intrinsic capacity, those on the decline and those whose intrinsic capacity has declines to the point of requiring assistance to perform basic tasks.
This program identifies older individuals suffering from multiple chronic conditions and frequently visit the hospital then focuses on giving them the clinical and care services at their comfort.
The objective of ICCE is;
Older people also experience difficulties on accessing health services even if they are available, this is more common in middle and low income countries. This is caused by difficulties in transportation given the condition of the roads may not be favorable for older people and sometime lack of funds to meet the transport costs. (Andeson, 2013.) In developing countries, it is estimated that about 60% of the older generation population either have no road access to a health care facility or cannot afford the cost (Aboderin and Kizito, 2010).
This therefore puts older people at a disadvantage since care services are mostly concentrated in cities away from the community. With older people requiring multiple care services, there is need for multi scrotal approach to provide health care that caters for the needs the older generation more conveniently.
The goals of ICCE are based on individual needs care and a larger outlook at the public health. The program achieves this through several strategies and resources such as–
Clinical care integration for older people should critical assessment, establishment of a care goal. This is based on the individual’s intrinsic capacity and a common care plan for care providers involved in the case.
These include
This requires several aspects to be put into consideration in order to meet the individual’s needs in his most preferred method. Based on a well-established primary health care system, service delivery includes;
These methods of service delivery aim to provide the older individuals with the correct information on their condition, educating them on the skills they need to manage it and providing the correct tools to do so effectively so at maintain the quality of life (Curry and Ham, 2010).
Community based care uses locally available resources to offer support to both the affected older people and their families.
To provide quality care for older people, care workers need to be competent in certain key skills. It is critical to have a well-trained and practically skilled workforce with a focus on complex cases is required to ensure care delivered is effective. (Oliver, et.al, 2014). A multi-disciplinary approach should be used when appointing health care workers for the community, so as to provide integrated person centered, care for people advanced in age. This may include the inclusion of counselors, care coordinators and self-management specialist (Valentijn, et. al, 2013).
To identify people’s needs, well-developed and maintained electronic records are used to essentially capture correct data, organize it and share it cross the multi-sectoral care departments involved in a person’s health. Correct assessments assist in identifying each individual’s patient’s needs and develop a care plan. Responses to each treatment method is then monitored while assessing the patient’s progress. This, always being based on standard measures anchored on the patient’s intrinsic capacity and functional ability. Given the fact that old people care may involves several health care worker some of whom may be drawn from different geographical locations, a common information system will facilitate easier collaboration of the health teams and their patients in providing best care.
In caring for older people, innovative technology will lead to development of good infrastructure and more effective control measures like vaccines. The system will allow for patients to have access to essential medicine in the easiest and most convenient way to them. Health care facilities should be designed in age friendly architecture. The aim is to enable older people remain healthy and self-reliant for longer through innovative and sustainable technology advancement (EIP, 2017).
According to WHO health financing is whereby all people can access medical care and health services without suffering financial hardships in the process. (WHO, 2015). Health financing policies are not independent but rather aligned to universally recognized health care goals for the older population. Proper financial coordination could include joint funding between health and primary care sectors to help improve service deivery in providing health care for the older population.
ICCOP employed the approach of WHO which is in line with the framework for people centered health care services as was adopted by the World Health Assembly in 2016. 39. It seeks a change in funding, management and delivery of health services. (WHO, 2017).
A five stage interdependent strategy is proposed to help and benefit the people through; (
This guidance meets the WHO requirements on older people care as expressed in the requirement to benefit people by creating an enabling environment where the patient, and community is empowered to make personal decisions in the right environment with the correct guidance. .
The main risk associated with ICCE concerns the withdrawal of long term case management where patients are seen to have development a dependency and therefore are at a health risk in case the long term management services are withdrawn. As such, the program seeks to identify other programs that can come into conjunction to assist n management of patients in transition from long term care to less dependent form of primary care. In such cases, programs like the Common Wealth Government Aged Care packages can be used but need to been agreed upon by all stakeholders and the type of care offered by the two programs differs but maintains same objectives.
This program aims to give them primary care that meets their individual needs for older people. Health providers are well skilled and trained in providing these services thus ensuring the patients’ safety. The use of information management and technology to support the program to ensure patients’ safety.
Regulations differ from country to country, the implementation of an integrated care system may be hindered by these regulations but each county is advised to develop its own program. Australia has the Coordinated Care Trials, Canada has the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA).
Each of these programs is aligned to the country’s regulations.
There cannot be enough emphasis laid on the importance of collecting the correct information by well skilled care givers and well recorded in an electronic system and updated at every stage of treatment. However, in the absence of electronic systems, especially where technology is a challenge like in low income areas, non-conventional methods such as fax an physical filing can also be relied on as long the correct information is stored. (Bodenheimer et.al, 2011).
Currently, ICCOP contributes to management of chronic disease and has led to positive results in lessening the frequency of hospital visits by older people. This is in line with the policy objectives to reduce hospital visit, chronic disease management and improved population health and positively impacting health care field. Future policies include widespread use of ICCE as an alternative to clinical systems.
The ICCOP is aligned to the National Safety and Quality Health Services (NSQHQ), policy of improving the quality of health care and protecting the public from harm. It aims to prolong the length of life for older people by giving them access to health care within their financial position in a way that will not risk them as they receive it.
Summary and Conclusions
Integrated Complex Care for the Elderly research has showed that integrated care leaves clients feeling less anxious and more supported while general practitioners are impressed with the results. This can be used to term the program a s a success in most countries where the practice id widespread.
The use of ICCE is an effective way of managing conditions that would have otherwise been more time consuming and costly to manage in a different setting given the number of medical practitioner that may have been employed and the cost of travel to hospital. This also helps older people live longer healthier lives and continue contributing to the society. As such, ICCE can be termed as an investment with better returns and compared to other health systems for handing chronic conditions in older people.
References
Aboderin, I. & Kizito, P. (2010) Dimensions and Determinants of Health In Old Age In Kenya. Nairobi: National Coordinating Agency for Population and Development, 2010, 20-22.
Anderson, G. (2013)The challenge of financing care for individuals with multimorbidities. In Health reform: meeting the challenge of ageing and multiple morbidities. Paris: Organization for Economic Co-operation and Development; 2013.
Australian Primary Health Care Research Institute for ADGP. (2006) Health Care Position Statement 2005, also included in the Australian Medical Association Primary Health Care position paper, 2006.
Coyte, P. Goodwin, N. & Laporte, A. (2008) How can the settings used to provide care to older people be balanced? Denmark: WHO Regional Office for Europe; 2008.
Curry, N. & Ham, C. (2010) Clinical and Service Integration: The Route to Improved
Outcomes. London: The King’s Fund, 2010, 13-17.
Esterman, J. & Ben-Tovim, I. (2002) The Australian Coordinated Care Trials: Success Or Failure? The second round of trials may provide more answers. Med J Aust. 2002 Nov 4; 177(9):469–70. PMID: 12405885
European Commission. (2013) European Innovation Partnership on Active and Healthy
Ageing. Excellent innovation for ageing: a European guide. Brussels: European Commission; 2013.
Nolte, E. & Pitchforth, E. (2014) Policy Summary II: What is the evidence on the economic impacts of integrated care? Geneva: World Health Organization; 2014.
Oliver, D. , Foot. C. & Humphries, R. (2014) Making Our Health and Care Systems Fit For an Ageing Population. London: The King’s Fund, 2014. 20-23.
Osborn, R., Moulds, D., Squirs. D, & Doty, M. (2014) International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient- Centered Care. Health Aff (Millwood). 2014 Dec; 33(12):2247–55.
Valentijn, P., Schepman, S., Opheij, W. & Bruijnzeels, A. (2013) Understanding Integrated Care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013 03 22; 13
Waren, M. (2012) Review of Non Hospital Based Services; Office of the Public
WHO. (2015) World Report on Ageing and Health. Geneva: World Health Organization; 2015.
WHO. (2016) Multisectoral Action for a Life Course Approach to Healthy Ageing: Draft Global Strategy and Plan of Action on Ageing And Health. Geneva: World Health Organization;
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