Malaysian Healthy Ageing Society Ms Susana Concordo Harding Dr Ng - PowerPoint PPT Presentation

Organised by: Co-Sponsored: Malaysian Healthy Ageing Society

• Ms Susana Concordo Harding • Dr Ng Wai Chong Ageing Well in the Community The Hua Mei Experience

Population Ageing & Health • Poor health, loss of function and need for long term care is one of the key “feared” burdens of population ageing • For governments, there is concern about health and long term care cost, and decreased productivity from older workers • For family, concern over care givers’ burden and need for institutional care • For Elders, poor quality of life and unhappiness in their last years

Population Ageing & Health Care • Optimizing health and well being throughout the life course is critically important for all • Preventing unnecessary acute and institutional care generally means better health, saves cost and helps support ageing in place, which is generally preferred by elders • Health care system must be able to provide a spectrum of quality care in the community to promote and enable ageing well in the community throughout the life course

Tsao Foundation’s Vision • Working towards wellbeing of older people through their life course by promoting and enabling: – Successful ageing • Goal = Every mature Singaporean with a personal successful ageing plan in health, finance and social support • Focus is on training, education and peer support on self efficacy and self care (including financial literacy, healthy living and chronic disease management) • Applicable to all older people but greater preventive value for the healthier, more functional older people – Ageing in place • Goal = Every older Singaporean can live securely and die peacefully in their own home • Focus is on integrated community frail care service system, caregiver support, and accessible built environment

The Three Initiatives of Tsao Foundation

Hua Mei Training Academy since 1993 as Hua Mei Training Centre  Hua Mei Training Academy – – Capacity building in ageing self care and care provisions  Professional Training in community aged care for – – professionals (as content provider for WDA, SSTI, etc. as well as our own signature courses i.e. community geriatric nursing) – community partners – volunteers  Training and coaching for individuals on successful ageing (“health, wealth and happiness”) through the life course  Caregiver support for sustainable care giving

International Longevity Center since 1996 as ‘Interagency Collaboration Division’  International Longevity Center –  Interagency Collaboration and policy advocacy through Policy relevant high impact ageing research and stakeholder platforms  “connecting the dots” between stakeholders – including older people, their families, practitioners, government, private sector

Hu Hua a Mei i Centre tre fo for r Successful cessful Ag Agein ing  Provides a one-stop centre for community aged-care Services – – Create a spectrum of community based program models – • To meet a range of needs from the well to the frail in the community • To optimize ability of individuals for preventive and self-care to age well • To enable access to the right service at the right time, right place and right cost to age in place • Each program is a stand-alone replicable model in its own right

The Theoretical Framework for Successful Ageing

WHO Active Ageing Policy Framework  Not just limited to the healthy, ambulant older people  Rests on three key pillars of: – Income Security – Health and access to health care – Participation  Defined not so much as a fixed end point but the opportunity and ability to optimize on the above at any time in one’s life course  Requires multi-pronged strategies at national policy, community action and individual behavioral levels

3 Pillars:  Income Security  Health & Health Care  Space for Participation Source: Active Ageing, A Policy Framework, World Health Organization, 2002

Successful Ageing Model Landmark MacArthur Foundation Study on Successful Aging in America (1995) Components nents of Succe cessfu sful Ag Aging  “Nurture (how we live) determines more than nature (our genes) on how well we age.”

Eden Alternative An ‘Alternative’ Culture of Elder -centred Care  Recognize the centrality of the human spirit  Health and social services are subservient  Physiological and security needs are not more important than the needs for companionship, dignity and self-actualization (the Three Plagues: Loneliness, Helplessness and Boredom)  Re-think and re-org care- activities towards ‘what really matters’

Hua Mei’s Delivery on Health

Central Importance of Primary Care in Population Ageing 7 C’s 1 st Contact – accessible, therapeutic relationship 1. 2. Continual – ‘Medical Home’, non -transitional 3. Comprehensive – Health promotion, disease prevention, restorative therapy, chronic disease management, long term care support, end of life care 4. Community-based – prevention from ‘stepping up’ into high -cost care settings, culturally relevant and acceptable 5. Coordinated – through working with Care Management services, integrated with other supports 6. Care and Counseling – emphasis on communication, self-care empowerment, caregiver supports 7. Cost Effective – the most-appropriately-qualified-lowest-cost person for the job

Primary Health Care Needs in a Life Course • Health First Act • Health Promotion Promotion • Disease • Disease Prevention • Health Prevention • Acute episodic Promotion • Acute episodic and restorative • Disease and restorative care Prevention Third Act care • Chronic Disease • Acute episodic • Chronic Disease Management and restorative Second Act Management care • Long Term Care Emphasis on Self Care • Psycho-geriatric Care • End of Life Care Aging is a ‘Life Course’. How we age depends on how we live in our youth: managing ‘health’, ‘wealth’, ‘relationships’ and other ‘departments’ of life.

An Integrated Approach to Health Inter-facing 3 delivery frameworks – Treatment Spirit – Self-care • Awareness Mind Body • Knowledge • Skills/practice • Motivation for sustained, positive Early rly Detec etecti tion on/ behavior towards a Dis isea ease se Primary imary preventi evention/ on/ healthy and effective Prev event ention on Immun uniza zati tions ns day-to-day practice Whole Person Care Acu cute te Illn lnes ess Health Promotion/ Wellness Enhancement End of Life e Chron onic c Disea sease se Care re Mana nagem gemen ent Long g term m care/ re/ Reha habili litati tation on Frail l care

Component Programs within Hua Mei Centre for Successful Ageing • ‘ Stand- alone’ Models that can be integrated around a Person as her needs shift with advancing age  “SCOPE”  Hua Mei Clinic  Hua Mei Care Management  Hua Mei Counselling and Coaching  Hua Mei Acupuncture and TCM Centre  Hua Mei EPICC  Hua Mei Mobile Clinic

Counseling and The TCM Coaching Clinic Review of past assessment +/- Comprehensive Care Management External Services Coordination, Geriatric Service “SCOPE” incl. Drs (where not available in- The Clinic Assessment house) High needs and very frail Occasional reversion with Rehab and case management Review of past assessment +/- Generally able Home-bound or Standardized to attend Day bedbound, near Home-based centre End of Life. Comprehensiv e Geriatric Assessment EPICC Mobile Clinic Primary Care + Care management in a Team

Mdm PAG, 75 yr lady who presented with a stroke 2 yrs ago. Referred to Hua Mei Care Management Service after discharge from hospital. Referred to Hua Mei Counselling and Coaching Referred to Work with HNF Programme for Hua Mei re medication management of Clinic for compliance depression when Primary Care son was arrested Social worker from Hua Mei Care Management Service arrange prison Liaise with MSW for financial visits and financial Routine assessment picked assistance (for eye operation). assistance up poor visual acuity Work with SAC for post op eye care. Referred for eye operation EPICC or Hua Mei Mobile Clinic if there should be deterioration in function or care arrangement

SCOPE  “Self Care on Health for Older People of Singapore”  An RCT research study on the impact of quality of chronic disease management by instilling health- education and life-skills coaching in small groups of older persons who attend SACs.

Hua Mei Clinic Created 1996 WHO Pilot Site for Age-friendly Primary Care Clinic The Age-friendly Principles, developed by the Age-friendly Advisory Group commissioned by the 2002 2 nd UN World Assembly on Ageing in Madrid, to guide primary health care centres in modifying their structures to better meet the needs of the older persons: Information, Education,  Communication and Training Health Care Management Systems  Physical Environment of the Primary  Health Care Centres  Supported by HMCM and the rest of the HMCSA