What is the system in Ireland for Providing Community

1. Innovation Symposium Collaborative Networks in AAL and Connected Health Fairways Hotel, Dundalk - Ireland 2 nd September 2010 Community, Services & Systems Metanoia ! Rodd Bond mriai Transforming social networks, environments and technologies for longer living. Dundalk Institute of Technology

3. Based on Appropriateness Evaluation Protocol (AEP) used in National Bed Utilisation Audit 2008. (Dr. D.Bedford studies) Reasons for admission Reasons for continuing stay AEP day of admission Severity of illness (10 criteria) Intensity of service (7) AEP day of care Medical procedures (10) Nursing/life support services (7) Patient’s condition (8) Cost/Benefit impact framework Services inter-relationships Nationally: 13% outside AEP admission criteria 39% outside AEP on day of care North East: 19% outside AEP admission criteria 47% outside AEP on day of care Secondary Care System older person A&E OP Clinics Inpatient D&T Primary care system GPs PCN/PCT HomeCare LTC Municipal / voluntary services HA NGOs Volunt. Prom /Prev

4. Acute hospital Out-patient Inpatient Outside AEP performance 2008 Alternatives Long term care Non-Acute Rehab Hospice Respite With Therapy Home GP Home care package Community nursing With Therapy Admission avoidance (19%) Cases/ Episodes 49 15 14 13 25 3 3 7 9 Discharges (42%) 23 38 10 38 23 20 20 15 Accelerate discharge (47%)

5. Outside AEP performance 2008 Some questions it raises Hospital centric: The solution for in-patient care is out-patient care. Technology: not well understood – HIH -> IV therapies Solution dependencies: on service capacities outside hospital The apparent low dependency on GP practice The invisibility of family, carers and volunteers The ‘quality’ of connected services and places - and the quality of the connections/communications Hospitals are ‘very expensive serviced hotels’ - the purpose of health system management is to minimise bed numbers and maximise bed utilisation ? Hospital avoidance and cure alternatives – not illness avoidance and health promotion and maintenance Assumption that the ‘inside AEP’ is coherent !? Acute hospital Out-patient Inpatient Non-Acute Rehab Hospice Respite With Therapy Home GP Home care package Community nursing With Therapy Long term care Cases/ Episodes 49 15 14 13 25 3 3 7 9 Discharges (42%) 23 38 10 38 23 20 20 15

6. Community / civic engagement Person-centred – empowerment Active ageing – wellness – learning Employment - participation Well-being promotion Injury prevention Acute Care Reduced independence Costs allocated to engagement and well-being and participation Costs allocated to prevention Current costs associated with the management of acute and chronic care Current costs associated with long term care Active Ageing Vulnerable Reducing Burden ? Liberating Bounty ? 85% 15% What problem: - to mould a paradigm shift More than a business case Need to re-balance investment priorities (flip the pyramid) in line with population Dynamics reflecting policy commitments to active and positive ageing.

8. Whose problem ? Which geographies and cultures ?

10. As co-designer As participant As subject As questioner Involvement complexity Contextual complexity As consumer Local Regional National EU/Intern. Building capacity to maximise pan-european involvement Mechanisms towards a better future User participation and co-ownership

12. As a starter: Which future do we want. Improving trajectories for longer living Technology view Market view Personal view Industry view Socio-political view