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

Philanthropic organization in Singapore – elderly care, water & sanitation and
preschool educat...
Project background and objectives

Background

 People are living longer and, in
some parts of the world,
healthier lives...
Our approach

Project
initiation

14 countries / 46 interviews

Secondary
research

Primary
research

Analysis &
Write-up
...
Interviewee profile

Norway (1)
Netherlands (3)
Finland (1)

Canada (3)

Germany (2)

Japan (5)

China (1)

Taiwan (1)

Un...
Top 3 findings

Finding

1

Sustainable funding for
elderly care is a critical issue

Finding

2

New models of integrated...
The rise and rise of the senior population
The world’s population is ageing progressively, mainly due to the aging baby bo...
The demand for elderly long term care
“The system of activities undertaken by informal caregivers and/or professionals to
...
Resource challenges

Low
availability
of elderly
LTC
services

Funding
constraints

Key supply pressures

Dwindling
health...
Reimagining
the future…..
Deliver person-centered care

Better ways of meeting the needs of patients and their carers including patient
centered app...
Integrate care & rethink medical care

Integration
■ Integrate care by bringing together various specialties of care staff...
Use the power of communities

Care setting (i.e. where people are cared for) – the options and what we think.
■ Aging in p...
Invest in the formal and informal workforce

Supporting the formal workforce
■ Empower caregivers
■ Provide relevant suppo...
Embrace technology

Long-term care is currently highly labor intensive – technology can bring about
significant efficienci...
Focus on outcomes

The overriding trend in healthcare is towards value (outcomes / costs) – so LTC
providers need to be in...
Develop better funding models

Sustainably funding long term care is a challenging issue

■ Countries are considering vari...
Carry out more research & Change attitudes to ageing

There is a limited amount of research on policy and much less consen...
Agenda for Action

Governments should:


Create a holistic elderly policy





Seek a sustainable funding model



Add...
Innovative solutions

Ideas for the future











Deliver person-cantered care
Integrate care
Rethink medica...
Case studies
Grand-Aides Foundation

Buurtzorg
■

Empowering care professionals – nurses work as
independent, responsible ...
Thinking about your audience

Long term elderly care is the most under examined, under serviced and ill
prepared area of t...
Trends in your market and potential services offerings

Some trends that are observed and repeated in different countries....
Many thanks to the
following
individuals for their
support…..

Expert panel:
• Nigel Edwards – UK (Project Co-Lead)
• Kath...
Nigel Edwards

Thank you

Director, Global Healthcare Practice
United Kingdom
Email: nigel.edwards@kpmg.co.uk

Dr. Loke Wa...
© 2013 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms
of the KPMG network of independ...
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An uncertain age: Reimagining long term care in the 21st century

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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.

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

  1. 1. An uncertain age: Reimagining long term care in the 21st century June 2013
  2. 2. 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 © 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. 2
  3. 3. Project background and objectives Background  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. Project 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. © 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. 3
  4. 4. Our approach Project initiation 14 countries / 46 interviews Secondary research Primary research Analysis & Write-up Validation Report Themes Australia Canada China The current state of long-term care Finland France Germany Hong Kong Japan Reimagining the future – ideas to overcome the ageing challenge Norway Singapore Taiwan The Netherlands United Kingdom Agenda for Action – steps that can be taken by governments, payers, providers, professionals, researchers, and users and carers United States © 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. 4
  5. 5. Interviewee profile Norway (1) Netherlands (3) Finland (1) Canada (3) Germany (2) Japan (5) China (1) Taiwan (1) United Kingdom (11) United States of America (8) Hong Kong (2) Singapore (4) Australia (3) Note: -1 interviewee was a UN individual – therefore had no nationality assigned © 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. 5
  6. 6. Top 3 findings Finding 1 Sustainable funding for elderly care is a critical issue Finding 2 New models of integrated care and a new approach to medicine in long term care Finding 3 Need for a national conversation about the elderly crisis © 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. 6
  7. 7. The rise and rise of the senior population 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. Shares of the population aged over 65 and 80 years in OECD countries, 2009–50 Source: OCED Labour Force and Demographic Database, 2010 © 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. 7
  8. 8. 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…” Population aged 65 years and over receiving long-term care, 2009 (or nearest year) Institutions % of population aged 65 years and 25 Institutions + Home Home 23.9 22.2 20 19.4 18.2 18.2 17.6 17.5 16.1 15 13.9 13.1 12.8 12.6 12.0 11.3 11.1 11.3 10 7.8 12.1 6.6 6.5 5.9 5.1 5 4.0 3.7 3.6 3.2 3.2 1.1 0.9 0 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. © 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. 8
  9. 9. Resource challenges Low availability of elderly LTC services Funding constraints Key supply pressures Dwindling healthcare workforce © 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. 9
  10. 10. Reimagining the future…..
  11. 11. 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 © 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. 11
  12. 12. Integrate care & rethink medical care Integration ■ 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 Redesigning medical input and changing the philosophy of medicine for elderly/ end-of-life: ■ 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 Program for All Inclusive Care for the Elderly (PACE) © 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. 12
  13. 13. 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 ■ 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 © 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. 13
  14. 14. 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 © 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. 14
  15. 15. 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 © 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. 15
  16. 16. 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. © 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. 16
  17. 17. 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 © 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. 17
  18. 18. Carry out more research & Change attitudes to ageing 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 International Longevity Centre Global Alliance © 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. 18
  19. 19. 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  Providers should: Users and carers should: Consider changing regulations to make homes and communities more age friendly and dementia-friendly.   Raise the reputation of the LTC sector and its workforce Researchers should:  Rethink the use of medication in a way that maximises quality of life  Develop new approaches to goal oriented medicine for people in LTC. Investigate new models of care delivery, technology, and other health services Research the effectiveness of drugs for the elderly and people with multiple pathology  Build the skills to deal with complex health and social care needs    Embrace technology  Reward quality and professionalism rather than cost cutting Incentivize integration, care planning and specialist medical input Improve the level of medical input to LTC Professionals should: Encourage providers to focus on the value they provide to the individual  Embed the right organisation values through staff recruitment and appraisal   Invest in staff training and support  Payers (national/local governments, social and private insurers) should: Integrate care to make it more person-centred/ develop care plans for individuals    Assert their rights, demand information and participate in planning. Produce international comparisons of developments and data Give more control to users and carers © 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. 19
  20. 20. 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) © 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. 20
  21. 21. Case studies Grand-Aides Foundation Buurtzorg ■ Empowering care professionals – nurses work as independent, responsible teams and are responsible for the complete process Based in Houston, US - recruits experienced and older local community members to function as nurse ‘extenders’ and provide care ■ 50% reduction in costs, better quality of care, higher work productivity and satisfaction 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% ■ Netherlands based home care provider organisation – Dutch Employer of the Year 2011 ■ ■ Eden Alternative Program for All Inclusive Care for the Elderly (PACE) ■ 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 ■ Reduce costs by delaying nursing home care/shortening hospital stays 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 Elderly attend day health centre – receive services from a multidisciplinary care team ■ ■ © 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. 21
  22. 22. 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? © 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. 22
  23. 23. 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 © 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. 23
  24. 24. 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
  25. 25. Nigel Edwards Thank you Director, Global Healthcare Practice United Kingdom Email: nigel.edwards@kpmg.co.uk Dr. Loke Wai Chiong Director, Global Healthcare Practice Singapore Email: wloke@kpmg.com.sg David Hansell Global Head, Human & Social Services COE United States Email: dahansell@kpmg.com
  26. 26. © 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.
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