Lessons from overseas on models for rural aged care

Clusters of universally designed communities serviced by home care providers and supported by assistive technologies could be a new model for aged services in rural and remote areas, says an executive who has explored international approaches.

Clusters of universally designed communities serviced by home care providers and supported by assistive technologies could be a new model for aged services in rural and remote areas, says an executive who has explored international approaches.

Caroline Langston, executive director strategy and development at North Metropolitan Health Service in Perth, recently travelled to Canada, Denmark, Scotland and the Netherlands to see how they delivered aged and dementia care in rural areas.

Of particular interest was the growing use of technology to support older people to live in their rural communities, said Ms Langston said, who undertook the trip as part of a Churchill Fellowship.

“In rural areas where you have large distances between older people, care workers have to drive out to see people, which takes a lot of time. But if there are ways of delivering services remotely, such as through telehealth or tele-monitoring, that means people can still get a level of service,” she told Australian Ageing Agenda.

In Canada, the Ontario Telehealth Network was providing chronic disease management of people living in their own homes, as well as providing an in-reach service into local residential aged care facilities.

“They had telehealth set up in an aged care facility through which psycho-geriatric support was provided, with a nurse practitioner employed to provide that primary care support as part of hospital avoidance and upskilling of staff. They do that really quite well,” Ms Langston said.

Similarly, Scotland has been running a major telehealth and telecare service as part of its involvement in a broader EU initiative investigating the use of technology in aged care.

The Scottish research explored the use of “total home monitoring” including sensors in the home monitoring movement, doors opening and closing and use of appliances like the cooker and fridge, she said. “They showed there’s great efficacy with those technologies; we undersell that people can actually use this technology whereas the Scottish experience shows older people will use these devices.”

The uptake of technology among seniors in Scotland had been bolstered by national programs educating older people about the internet and ICT, and how it could help them, Ms Langston said.

Denmark, which was the other half of the EU research project, investigated the use of remote monitoring of chronic disease, she said. “Devices in the person’s home took a range of measurements and vital signs which were automatically fed to the laptop of a community health nurse who monitored the results and could follow up with the person if needed.”

Overarching strategy in place

Asked what common elements the various successful initiatives shared, Ms Langston said they all followed a national aged and dementia strategy which was essential in outlining goals and approaches.

Many of them focused on community development capacity, and using peer-to-peer support and adoption of dementia or age-friendly principles in their communities, she said.

They also utilised technology to ensure expert advice and support could be fed remotely into small regional and remote aged care facilities.

“They were doing that in terms of mental health services to better manage behavioural issues, and also nurse practitioners who were helping hospital avoidance,” said Ms Langston.

“Because these are small aged care facilities in our rural communities, so the question is how do we support them to remain viable and to access that expert care,” she said.

Grouped age-friendly accommodation

Other communities were turning to cluster-style arrangements of housing, to effectively close the geographic gap between older people and services, and using universal design to ensure accommodation supported people as they aged.

“When they’re grouped in a cluster, community services can go in there quite quickly and easily, they’re not having to drive large distances to see clients. It also means private providers can come in as well, because now you have economies of scale. That’s where some of the ‘choice’ around CDC will start to happen in rural areas.

“If we can group people together in small communities, build age-friendly housing, you will maintain those people in our communities much longer, rather than them having to move to aged care facilities prematurely, and often out of town,” said Ms Langston.

The clustered accommodation could be supported by the use of assistive technology and home monitoring, which would further support the community care workers as they delivered care and support to clients, she said.

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Tags: aged-care, assistive technology, churchill-fellowship, ontario telehealth, rural-and-remote, telecare, telemedicine,

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