Day 1 - Health Metrics World Conference 2017

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World
Conference
2017
Innovation Technology
for Health and Wellbeing
Contents / page number:
2 - Nicholas Gruen, Lateral Economics
68 - Jalmes Hall, Pitney Bowes
113 - Julie McStay, Hynes Legal
147 - Robert Clifford, Alto Cibum
176- Susanne Jones, Just Better Care
187 - Dr Andrew Fleming, One Fell Swoop

@ngruen1
Health Metrics
Nicholas Gruenngruen@lateraleconomics.com.au
21st Sept 2017
Asking the right questions: Forecasting, data and innovation in aged
care and beyond

@ngruen1
Outline
2
Economics and forecasts
– The economy
– Your sector
Adventures in data
– Kaggle
– The Gruen Tender
Innovation
– The challenge of putting users first
– Creating the future

@ngruen1
"Prediction is very difficult, especially if it's about the
future." Niels Bohr
5

@ngruen1
“The UK ﬁnancial system remains highly resilient.”

Bank of England 2007 Financial Stability Report
6

@ngruen1
'00s of CFOs asked to forecast yearly returns for S&P 500
over nine-years
80% confidence intervals
30% confidence intervals
Projections are even further off the mark
–  desire to succeed engenders optimism bias
8

@ngruen1
Focus on risks not forecasts
10

@ngruen1
Charlie Munger
It is remarkable how much
long-term advantage people
like us have gotten by trying
to be consistently not stupid,
instead of trying to be very
intelligent.
Knowing what you don’t know
is more useful than being
brilliant.
Acknowledging what you
don’t know is the dawning of
wisdom.
11

@ngruen1
If your focus is
your ignorance,
you’ll focus on
risks not forecasts
13

@ngruen1
Forecasting aged care
15

@ngruen1 Aged Care Financing Authority Forecasts 18
@ngruen1

@ngruen1 21
Innovation in
aged care

@ngruen1
Adventures in data
22

@ngruen1
Where’s wally?
Kaggle

@ngruen1
Competition Mechanics

@ngruen1
Global Competitions
State of the art 70%
1½ weeks 70.8%
Competition closes 77%
Predicting HIV viral load
Accuracy of Prediction (1 – 100%)
Chris Raimondi
Baltimore

@ngruen1
Successful
grant applications
~25%
“The world’s brightest
physicists have been working
for decades on solving one of
the great unifying problems of
our universe”
“In less than a week . . . a PhD
student in glaciology,
outperformed the state-of-the-
art algorithms”

@ngruen1
Where’s Wally from?

@ngruen1 32
Should we publish death rates in hospitals?
–  Pros?
•  Transparency
•  Consumer choice
–  Cons?
•  Incentives
•  Culture
Information, transparency and incentives

@ngruen1 33
Performance measurement and motivation
Ideal behaviour
Performance
MeasurementReduce deaths
Turning away
bad risks

@ngruen1 34
Gruen Tenders
Provide unbiased estimate of the prognosis of a clinical procedure.
This can be used for
–  measurement of clinical safety,
–  allocation and
–  funding of clinical work
Well suited to self contained clinical event with reasonable chance of
undesired outcome from which full recovery expected - obstetric
delivery, setting a fracture, cardiac surgery

@ngruen1 35
Agent 1
Agent 2
Agent 3
Prognosis
420,000$
415,000$
450,000$
Accuracy of past
prognoses
5%
-2%
-15%
Expected
price
441,000$
406,700$
382,500$
Indicated Service provider
Gruen Tenders

@ngruen1 36
Hospital A
Hospital B
Hospital C
Raw
Prognosis
2.0%
4.0%
1.5%
Correction for
accuracy of past
prognoses
-30%
25%
30%
Expected
chance of
adverse event
1.40%
5.00%
1.95%
Indicated Service provider
Gruen Tenders

@ngruen1 37
Gruen tenders minimise perverse incentives
There is no incentive to turn anyone away, just to reduce the
attractiveness of the ‘bid’
No incentive to ‘reclassify’ risk rating
–  Because risk rating is not imposed extrinsically, but
intrinsically to the clinical unit
–  In the ‘prognostic bid’.

@ngruen1 38
Gruen tenders facilitate innovation
‘Risk rating’ isn’t done by formula or from historical stats
It’s done by the practitioners themselves

@ngruen1 39
Gruen tenders reinforce intrinsic motivation
Information that aligns with intrinsic motivation should reinforce it
Where perverse incentives (to turn patients away) destroys it

@ngruen1 40
Gruen tenders assist central funders
and managers, and educate patients
Gruen Tenders generate a mass of data on top of the basic
performance data currently used for report cards.
–  Data from prognoses, and availability of comparative prognoses
on the same case
Re the lack of consumer response to report cards, Gruen
Tenders put the info – and the issue in front of patients.

@ngruen1 41
Ideal behaviour
Innovation
Caring
Performance
Measurement

@ngruen1 42
Gruen Tender/
Performance
Measurement
Ideal behaviour
Innovation
Caring

@ngruen1
Innovating with human beings
43

@ngruen1
Design: evidence based delivery
47

@ngruen1 48
What kind of data
do we need?

@ngruen1
Data on what causes what
“Our success at Amazon is a function of how many experiments we do per year, per
month, per week, per day….”
Jeff Bezos
“Last year at Google the search team ran about 6,000 experiments and implemented
around 500 improvements based on those experiments. The ad side of the business did
about the same. Any time you use Google, you are in many treatment and control
groups. The learning from those experiments is fed back into production and the system
continuously improves.”
Hal Varian, chief economist at Google
49

@ngruen1
Design: evidence based delivery
50

@ngruen1 52
I’ve worked with that
family for 3 years and I
just learnt more about
them in 2 hours.
Case worker
Families commented:
“you’re the only one
who has ever asked
what would work for my
family”.
Family coach

@ngruen1
Nudge Unit
54
Engaging the life world of the other
Behavioural economics and design are new fads
embodying ancient principles of understanding others
Easily scalable engagement Deep engagement

@ngruen1 55
Innovation in
aged care

@ngruen1
Open source
58
Community aged care
Palliative Care
Residential Aged Care

@ngruen1 62
Innovation in
aged care

@ngruen1 63
Innovation in
aged care

@ngruen1 64
Place Besserer at
Bruyère Village
For couples with
different care needs

James Hall
Consultant – Location Intelligence
Leveraging Location Intelligence
to identify and engage with customers
in the Health and Aged Care Sector

Agenda
• History of Location Intelligence
• Pitney Bowes
• Use cases for the Health and Aged Care Sector
• Partnership Introduction

Geographic Information Systems

Technology Analysts view Location as
“The Next Champion of Analytics.”
Present… Location Intelligence

The Future – Internet of Things… Big Data…

Location Intelligence & Health

“People who are really serious about Spatial Software
should make their own Data”
- Me

Estimates and Projections Consumer Spend Potential
Daytime Population CAMEO – Geo-demographic Segmentation
370 Datasets – 240 Geographies

Data is the most valuable asset of any business and is the
foundation for building lifetime customer relationships

Use cases for the Health and Aged Care Sector

Health and Aged Care Provider
• Builds, owns and operates Health clinics
and Aged Care Facilities
• Community Screening initiatives
Winterfell Health
Challenges
• Mobile screening
• Next best location
• Customer engagement

Where to locate mobile community health screening

Next best location – Medical Clinic

Next best location – Residential Aged Care

Pitney Bowes |
Reservoir
Thomastown

• Personalized
• Interactive
• 24/7
Video

Personalised Video
Support decision making
• Distance to shops, cafes, parks
• Neighborhood composition – language, ethnicity, Religion
• Distance from primary contact (Drive times)
Support onboarding
• Daily routine for required care level
• Emergency procedures
• Billing FAQs

Understanding the paradox between
consumer choice and duty of care
Presented by
Julie McStay, Director

Overview
• Duty of care and rights and responsibilities
• Risks and risk prevention
• RACF residents engaging in risky behaviours
• Balancing consumer choice and duty of care:
– in retirement village context
– in home care context

Duty of care and rights and
responsibilities

Duty of care – what is it?
• a duty of care is a legal obligation which is
imposed on an individual to provide a standard of
reasonable care while performing any act that
could foreseeably harm others.
• Do all that is reasonably necessary to minimise
the risk of foreseeable harm

Who owes a duty of care?
• AP to staff
– to act as a reasonable employer
– to take reasonable steps to ensure staff are
not injured
• AP to care recipients
– to meet residential care requirements
– to take reasonable steps to ensure residents
are not injured
5

Who owes a duty of care?
• Staff to AP
– to act as a reasonable employee
– to follow policies and procedures
• Staff to care recipients
– to provide required level of care
– to provide for protection and general safety
6

Care recipients’ rights
• to maintain his or her personal independence
• to accept personal responsibility for his or her
own actions and choices, even though these may
involve an element of risk, because the care
recipient has the right to accept the risk and not
to have the risk used as a ground for preventing
or restricting his or her actions and choices

Foreseeable risks in aged care
• Lack of clinical oversight
• Medication management
• Medication errors
• Falls
• Swallowing
• Assaults
• Care recipient absconding
• Deterioration in condition
• Use of restraints
Presentation Slide 9

Balancing consumer choice and duty
of care in residential care

Residents engaging in risky
behaviours
• Balance of risk vs resident wishes and quality of
life
• Residents should be supported to remain
independent
• Use of risk waivers?
11

Case study 1
• A resident has mild dementia.
• Pressure areas, does not like to be turned and wont
agree to change his mattress
• The resident is resistant to care and is physically
abusive to staff when they try to assist him.
• The care staff stop offering to turn him and give up
trying to get a new mattress on the bed on the basis
that they say they have “a duty of care to respect his
wishes”
• Thoughts???

Case study 2
• Resident assessed as requiring assistance to
mobilise
• Attempts by staff to assist provoke aggression
• Unaided mobilisation resulting in falls
• Physical violence and aggression towards staff,
other residents and the visitor of another resident

Case study 3
• Resident moved from co-located RV to RAC
• Not secure unit
• Liked to go walking – had capacity and chose to
disregard road safety
• Condition deteriorated – two incidents of concern
• Security of tenure

Case study 4
• Resident enters facility in 2008
• Resident had been using a bed pole at home
• Daughter asks EN for bed pole
• EN does not document conversation with family
• EN does not inform any other staff about the bed pole
15

Case study 4 – Coroner’s
findings and Department alert
• May 2010 SA Coroner’s findings about bed poles
following death resulting from asphyxiation due to
entrapment in bed pole
• June 2010, Department releases urgent bulletin to
approved providers recommend that bed poles only be
used in RACF:
– resident has appropriate health professional assessment
– use is frequently monitored
– consent
16

Case study 4
• Facility manager sends email to all RNs and ENs
advising:
– all bed poles must be removed
– if resident insists on keeping bed pole, “Risk
Taking Activity” consent form must be signed
17

Case study 4 – Issues
• Resident’s condition significantly deteriorates
• Resident found entrapped in bed pole on night
shift
– No evidence that the resident whose daughter wanted
the bed pole signed a risk form
– No documented conversations about the risks
associated with bed pole use
18

Case study 5
• Resident had mental health issues
• Smoker – wants to smoke
• Staff smelled smoke on balcony
• Resident found with burnt clothes on the ground
and burns to body
• Resident informed staff he tried to set himself on
fire and take other residents with him
19

Case study 6
• Challenging behaviours – two residents
• They have both displayed challenging
behaviours in the past but wish to continue living
in this service
• Dispute between residents
• On resident pushes another
• The resident falls, hits her head and passes
away
20

Risk prevention for APs
• Regulator/Court will consider
– probability that harm would occur if care was
not taken
– likely seriousness of the harm
– burden of taking precautions to avoid harm
– social need for the activities creating the risk

Risk prevention for APs
• Communication
• Documentation
• Hand over procedures
• Training
• Policies that are implemented and monitored
• Check qualifications and references
• Follow up complaints
• Incident management

Risk prevention – points to
remember
• Accurate and comprehensive documentation
• Provide access to training and induction that
includes information about duty of care
• Provide access to internal and external services
to deal with issues that challenge duty of care
• Ensure resident’s and family participate in
decision making
• Discuss duty of care issues with staff

of care in RV

Home care in RVs – risk issues
• New entrants
• Regulatory – Aged Care Act, RV Act, others
• Contractual – relationships with providers and
clients
• Reputational – managing incidents and
complaints
• Financial
• Consumer directed care

Case study 7 – RV
[Giese 2013]
26
• Resident of retirement village
• Myocardial infarction
• Deceased discovered some time after death

Delivery of care
and your risk profile
• More risk/higher duty
• Response to risk needs to be proportionate to
consequences
• Recent Coroners matters indicate you must
assess and have plans in place to respond to
high risks
27

of care in home care

Case study 8 – Home care
• Consumer directed care provides freedom of
choice …
• But what if family member wants to manage all
administrative aspects of the package and pay
no admin or case management fees?

choice …
• But what if client wants someone at home to
perform nursing services?

choice …
• But what if the consumer wants to go without
necessary clinical services to save for a more
expensive non-clinical service?

Care recipient independence
vs increased provider regulation
• More onerous obligations on home care
providers
– Eg policies and procedures
– Monitoring, oversight, documentation,
communication with client/representatives
• Balance with care recipient independence?
• Assumption of risk by home care providers

Contact
Julie McStay, Director
Julie.mcstay@hyneslegal.com.au
07 3193 0503

My Story
ExperienceAgedCare
Storm Coming
FoodExperience
Place making
Physical Environment
People
Planet
Product
Program
Summary
AGENDA

5 Star Hotels
Perth/Canberra/China
Iconic Venues
ParliamentHouse of Australia,MCG, Melbourne Town Hall, NZ Parliament,
MostAustralian Stadiums
World Class Events
Grand Prix, Spring Racing Carnival Bird Cage, Masters, Open, Wimbledon,
Irish Open, PresidentsCup,APEC ,CHOGM

WHOLE NEW WORLD
• Appointed GM Food Development
• Exposure to Aged Care/ Health
and Resources Catering
• The party was over!

• Low daily allowance $
• High % Frozen Food
• Staff not engaged
• Environments not
encouraging
MY EXPERIENCE
OF AGED CARE

THERE'S A
STORM COMING!
• Apprentice Chefs at Record Lows
• People Living Longer demand will grow
• Aged Care Big Business – Profit pressures
• Food Bowl Shrinking
• Expectations will continue to grow

8 / 29 MCC - LUXURY| FUTUREFOOD – JULY2017
I REALLY HOPE THINGS CHANGE BEFORE I GET OLD!

13/ 29 MCC - LUXURY| FUTUREFOOD – JULY2017
$
It not all about
the Money!

FOOD & BEVERAGE
- IS AN EXPERIENCE
• Its not just about the food
• Aged Care facilities have the
same needs as many
hospitality precincts
• We should strive to create a
positive experience
• Adopt Place Making Principles

Physical
Environment People Planet Product Program
5 P’S OF PLACEMAKING

PHYSICAL
ENVIRONMENT
• Create Spaces where people
want to be
• Bring the kitchen table back
• Where is the Heart of a Home?

PHYSICAL
ENVIRONMENT

PEOPLE
• Ownership – know your business
• Food cost
• Menus
• Nutrition
• Wastage
• Cannot be outsourced
• You are a Venue Manager and Food
is over 60% of the experience
• Technology now makes this possible.

FULLY AUTOMATED
NUTRITION
ANALYSIS
DIRECT
CONNECTION TO
SUPPLIERS
COST & MARGIN
MANAGEMENT
MENU MANAGEMENT SYSTEMS, SPECIFICALLY DEVEOPED FOR THE AUSTRALIAN MARKET
PEOPLE

PEOPLE
• Encourage Connect through
people and food.
• Remove barriers.
• Bring back the family!

Employ for attitude.
Don’t need Manu and
George C in the kitchen.
PEOPLE

Give them every
reason to value their
work and daily rituals
PEOPLE

PLANET
Gardens are Great!
Curated Gardens

Bees are Better!
Roof Tops, Corner Plots.
Don’t let the naysayers win!
PLANET

• Create a Food Philosophy.
• Live by it.
• Cage Free Eggs
• Free Range Chicken
• Be practical
PLANET

PRODUCT
Specialty Molds
– 3D Printing??

Don’t forget we eat with our eyes?
Care about presentation.
PRODUCT

• Make&Bake
• MakefreshPasta
• Bakefreshscones,
biscuits,muffins
PRODUCT

Outlaw the baddies! –
No Packet Soups
Make In house Stock
PRODUCT

• Be practical!
• Small goals aligned with Skills and Resources
• Slow cook cheaper cuts.
• Rotate Frozen supplemented by kitchen
• Regularly compare costs fresh/frozen etc.
• Sample & cost pre made meals.
• Mix up in house prep, pre made, fresh, frozen.
PRODUCT

PROGRAM
Curated Environments for the
Excitement and pleasure of
everyone.
• Music
• Live Cooking
• Cooking Classes for relatives
• Specialty Nights, National Nights
• Fondue Nights, Quiz nights
• Expand the target group

HEART OF
THE HOUSE IS
THE KITCHEN
Summary
• People – Encourage Connection , Value
Kitchen Teams
• Physical Environment- Create environments
where people want to be!
• Planet – Embrace Nature as much as possible.
• Product – Make “1” specialty item a day.
• Program – Create activity schedules that
encourage participation and deliver an
experience.

Phone +61 0407449672
Web www.altobcibum.com
Email rclifford@altocibum.com
STAYON
TREND
ROBERT CLIFFORD
GENERAL MANAGER
THANK YOU

Providing a flexible,
whole of life approach
to in-home care
Presented by:
Susanne Jones

www.healthmetrics.com.au
Susanne Jones
susanne.jones@justbettercare.com
0450 667 370

Future ageing, living and care
2025 and beyond
Dr Andrew Fleming
Ageing & Living Director

Advisory OperationsProduct Marketing Sales

1. Introduction
2. Australian demographics
3. Roadmaps and scenarios
4. Future customers
5. Seniors living
6. Models of care
7. Future home care
8. Assistive technologies
9. Future residential care
10. Small scale dementia care
11. Conclusion
Agenda

Retirement living:
• Approximately 200,000 Australians or 5.7% of people aged 65+ live in a village
• Average age of residents – 81 years
• By 2025 the number of residents will double in number to 7.5% of 65+ population
Dementia:
• In 2017 more than 413,000 people are living with dementia
• By 2056 this will increase to more than 1.1 million people
• One in ten people aged 65+ will develop dementia
• Three in ten people aged 85+ will develop dementia
• Dementia prevalence 80 - 84 years 11% for males, 14% for females
Australian demographics

Year 65 - 74 age group % 75 - 84 age group % 85+ age group %
2016 57 30 13
2024 45 35 19
Source: Australian Institute of Health and Welfare (2017). Older Australia at a glance. Australian Government.

Year Men
at birth
Women
at birth
Men
aged 65
Men
aged 85
Women
aged 65
Women
aged 85
2013 - 151
80.4 84.5 19.5 6.2 22.3 7.2
20302
>83 >87 >20 No data >23 No data
1.
Australian Institute of Health and Welfare (2017). Life expectancy. Australian Government.
2.
Kontis, V et al. (2017). Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. Lancet, 389: 1323-
35. Online – http://dx.doi.org/10.1016/S0140-6736(16)32381-9

Future Aged Care
Australian Government Agenda
• A seamless aged care system that is market-based, consumer driven,
with access based on assessed need
• Seamless movement between home-based and residential care with
actual consumer choice of care and provider across the spectrum
• Uncapped supply
• No distinction between care at home and residential care, creating a
single aged care system — agnostic as to where care is received
Aged Care Road Map 2016, Aged Care Sector Committee

Seniors Living - Last 30 years
55+ Lifestyle Village
Remain at home
Low
care
High
care
Aged care
Length of stay
36-48 months
Traditional Retirement
Village - some with care
55 60 65 70 80 85 95

Seniors Living - Next 30 years
55+ Lifestyle Village
Remain at home with in-home care if necessary
Assisted
living
Aged
care
Retirement Village
with care capacity
55 60 65 70 80 85 95
Length of stay
12 months

Future Residential Aged Care Demand
• Increased Home Care Supply
“A major factor in future entry rates will be the continuing expansion of the home care program,
which is expected to result in proportionally fewer people entering permanent residential care”
Aged Care Financing Authority - Fifth report on the Funding and Financing of the Aged Care Sector July 2017
• The likelihood of Level 5 and 6 Home Care Packages
• Declining length of stay

RAC Places
500,000
450,000
400,000
350,000
300,000
250,000
200,000
150,000
100,000
50,000
Demand of Places Forecast – Based on Government Rate Demand of Places Forecast – 12 months LoS
Demand of Places Forecast – 24 months LoS Demand of Places Forecast – 6 months LoS
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2050: RAC places demand and supply

Future organisations
• Recognise the value of mission and purpose to business success
• Embed culture and values in all products and services
• Build purpose and meaning to return greater employee satisfaction,
consumer advocacy and loyalty
• Adopt customer-centred approaches rather than organisation-centred marketing
• Co-production leads the design of products and services
• Consumers feel they are at the heart of service offering
Reference: Attrill, H. (2016). The value of mission to business. Community Care Review, February 2016.

Successful retirement is underpinned by:
1. Financial security – the foundation.
2. Build up the social network to replace the former work community.
3. A life with purpose and challenging one’s mind.
4. Ongoing personal development – exploring, questioning and learning.
5. Having fun.
What will retirees want?

“An active process of becoming aware of and making choices toward a more successful
existence or healthy and fulfilling life” (WHO, 1998)
Wellness?

‘Front of mind’ is:
• Increased expectations and a culture of entitlement
• Downsize not downgrade
- Aspirational downsizers
- Maintain pre-retirement lifestyle and explore other opportunities
- Individual choice and control
‘Front of house’ is:
• Normality
• Hospitality
• Lifestyle
- Health
- Wellness
Rising Expectations

‘Back of mind’ is care:
• “It is good to know it (care) is there when I might need it BUT I won’t talk about it right now”
• It signifies disability, dependency, decline and the road to death
‘Back of house’ is:
• ADL support
• Clinical care
Rising Expectations

Increasing affluence
• Future over 65 ‘Baby Boomers’ will be the richest we have seen to
date
Changing tastes
• The traditional purchaser of retirement living is changing
• Living life to the full is more important than leaving an inheritance
Changing expectations

“Housing with care is an accommodation response to the increase in manageable care needs
and desires of older people to remain in a home of their own for as long as possible”
(JLL – Retirement Living, Where is the Opportunity, 2015, UK)
“Residents of today and tomorrow want the real total package—and that includes care and
wellness within arm’s reach”
(Senior Housing News, 2017, USA)
Why?

2025 and beyond - Expectations

Retirement and care accommodation, residential aged care, and dementia care
Seniors living precincts will bring to the community a range of contemporary seniors living
accommodation and care models with extensive community and activation facilities
• Residential care will accommodate persons who require 24/7 clinical care, including
complex health issues and palliative care
• Dementia care will take the form of providing small houses of residents in a home like
environment
• Care accommodation will provide serviced apartments that offer daily meals, cleaning,
laundry and other assistance with daily living
• Retirement accommodation offers fully accessible seniors living for persons to
age-in-place and die-in-place
Seniors living precincts

Apartments | Villas | Vertical?

• Biophilic Design: the positive benefits of
interaction with nature
• Important for physical health and well-being
• Integration of nature and natural elements,
materials and forms into architecture and interiors.
Natural world connectedness

2025 - new business opportunities

1. Resident centred and directed
2. Health and wellness
3. Health literacy
4. Dignity of risk
5. Natural world connectedness
6. Social relational emphasis
7. Clinical governance
8. Best practice
9. A palliative approach
10. Program evaluation
Models of care - principles

• Leadership and culture
• Safe systems
• Education and training
• Care audit and monitoring
• Research and developments
• Transparency and openness
• Risk management
Clinical governance

Future Home Care - trends
• Expansion of the home care program to meet 45 per 1000 ratio
• Post February 27 2017:
- Multiple operators driving competition and innovation
- Consumers will request to move from existing provider to new provider
- Consumers moving to new operators who were previously ‘sub contractors’
- Retirement living sector expanding into home care operations
• The challenge to meet the increasing clinical care needs of home care consumers
Courtesy of Lorraine Poulos

Future Home Care – Staff Skill Mix
• Technology literate and enabled workforce
• Effective case management by trained case managers
• Customer service as a core skill
• Clinical staff availability – RN, EN
• Palliative care internal and external resources

Assistive technologiesAssistive technologies

Emerging Technologies: Care at Home
• GPS technology
• Personal Emergency Response Systems
• Medication Reminders
• Wireless Home Monitoring
• User-Friendly Computer Interfaces
• Health Tracking Tools
• Online Community Networking and Support

GPS tracking
A 2016 US simulation study
• Assessed the time to locate missing persons under various outdoor scenarios using RF locator
devices and GPS devices
• Each device was tested three times in each of three scenarios (open, wooded, and urban).
• GPS devices were almost twice as time-effective in finding the wanderer and performed better
over larger distances.

Future End-of-life Residential Care
• Physical environments will support:
- Continued use of the senses
- A sense of familiarity and homeliness
- Access to the outdoors and the natural environment
- Engagement with spiritual aspects of life
- Social engagement and being with family
- Calmness, privacy and foster dignity
- Safety and security
- The facilitation of nursing care and application of emerging technology
Dementia Collaborative Research Centre, January 2014. Defining the desirable characteristics of physical environments for the delivery of
support and care to people in the late stages of dementia.

Future Residential Care – Staff Skill Mix
• Technology literate and enabled workforce
• Nurse practitioners in partnership with GPs managing care
• Partnerships with acute care services
• RNs acting as clinical leaders with core skills of:
- Advanced physical assessment
- Wound care
- Palliative care
- Behaviour assessment and management
• Direct care workers with core skills of:
- Customer service
- Conflict prevention and resolution (assault avoidance disengagement)

• De Hogeweyk model of care for people with severe dementia
• A social-relational model of care for persons living with dementia
• Small, normal human scale living for 6-7 persons who share similar social values and lifestyles
• Interiors as a link to how it used to be, tailored to everyone e.g. Artisan, Cultural
• Participation in meaningful activities and social life
• Composition of outdoor public spaces such as gardens and streets
• ‘Front of house’ is normal life, ‘back of house’ is care and support
Small scale dementia care

2025 and beyond - Sustainable organisations

Day 1 - Health Metrics World Conference 2017

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