a trend for establishing community care system in indonesia

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A TREND FOR ESTABLISHING COMMUNITY CARE SYSTEM IN INDONESIA TRI BUDI W. RAHARDJO AND ASVIRETTY NURGUSMY YERLY FORUM ON CONCEPTION OF HARMONIZATION OF LONG TERM CARE CERTIFICATE BETWEEN JAPAN AND INDONESIA FUKUOKA CITY 10 AUGUST 2014

Transcript of a trend for establishing community care system in indonesia

Page 1: a trend for establishing community care system in indonesia

A TREND FOR ESTABLISHING COMMUNITY CARE SYSTEM

IN INDONESIATRI BUDI W. RAHARDJO AND ASVIRETTY NURGUSMY YERLY

FORUM ON CONCEPTION OF HARMONIZATION OF LONG TERM CARE CERTIFICATE

BETWEEN JAPAN AND INDONESIA

FUKUOKA CITY 10 AUGUST 2014

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CONTRIBUTORS

Eva Sabdono ( Yayasan Emong Lansia/HelpAge Indonesia)

Vita Priantinadewi ( Centre for Ageing Studies, University of Indonesia)

Dinni Augustin( Centre for Ageing Studies, University of Indonesia)

Rodiyah Soekardi ( Faculty of Health Sciences, University of Respati, Yogyakarta)

Lestariningsih ( Faculty of Health Sciences, University of Respati, Yogyakarta)

Tri Mei Khasana ( Faculty of Health Sciences, University of Respati, Yogyakarta)

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Background Indonesia, as the fourth most populous

country, has the tenth largest elderly population.

In 2020, the number of older people is estimated to have steadily increased to 28.8 2million (11 % of the total population), while the under five population will gradually decrease in number.

In 2050 it is estimated that the absolute number of 60+ will be around 80 million.

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Background

Ideally population ageing should be accompanied by longer period of good health, a sustained sense of well-being, and extended periods of social engagement and productivity.

Alternatively, ageing will be associated with more illness, disability, and dependency

Hence, Long Term Care (LTC) and Integrated Community Care for older persons is highly needed

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Background

In developing country like Indonesia, providing home and community long term care can enable older persons with care, who need to stay at home as long as possible.

This can help greatly improve their situation, and it is what most want

Also, supporting older persons in their own home generally costs less than keeping them in a nursing home or other residential care option.

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Definition of Long Term Care (LTC)

WHO defines Long Term Care (LTC) as a system of activities undertaken by informal caregivers , or professionals to ensure that a person who is not fully capable of self care, can maintain the highest possible quality of life , according to his or her preferences, with the greatest possible degree onindependence, autonomy, participation, personal fulfillment and humanity

( Ekachai and Puangpen, 2012)

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Home Care

“Home care” according to HelpAge International 2003 generally refers to professional or formal services that assist older people in the tasks of daily life, allowing them to remain in their homes

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Home Care in Indonesia

In Indonesia, home care mostly are provided by informal care givers particularly family .It means, that home care in this setting refers to family care

“family care” refers to the informal care of older people by close relatives, usually a spouse or adult child.

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Home Care Services

Some of home care services are provided by skilled care givers who assist the family in providing daily life assistance including bathing, dressing and undressing, getting into and out of bed or on and off the toilet, preparing meals, taking medication, housework, managing money, going to the doctor/Primary Health Centers , shopping, making phone calls, writing letters and keeping in touch with family and friends

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Best practices of HC by NGO

HC Services mentioned above are conducted very well if the partnership between health and social services is very good in a health and social system like the one in Yogyakarta by Cita Sehat , and Emong Lansia in Jakarta, ,Vina Dulcedo in East Nusa Tenggara and Yayasan …., Cantayam Sukabumi, West Java

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Community Care

“community care” is defined by the WHO as “services and support to help people with care needs to live as independently as possible in their communities”

In Indonesia there is a trend to establish a community care as Integrated Community Care

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Integrated Community Care

We realize that older people need assistance more than basic assistance with ADL , particularly the ones who are still independent with high score of ADL . Community care in this case provide day care facilities , in general it is called Integrated Community Care Post for older people and pre older people ( Posyandu Lansia)

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Posyandu Lansia Services

In this post, several services are provided by the caders ( social workers ) and or health providers.

There are 70 000 Posyandu Lansia in Indonesia, in which regular health check done regularly to maintain health and wellbeing for older people.

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Other activities at PosyanduLansia Other activities at Posyandu Lansia include

regular exercise , small scale business, community education, religious activities, recreation, etc

Some Posyandu Lansia provides home care if it is needed , such as the one who need long term care done by caders and or the family and supported by nurse as home nursing

It seems that long term care has not been understood

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Result of Study on Institutional and Community Care giving for Older People

1. Care giving to promote Active Ageing and Wellness Program

2. Quality of Life

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Care giving to promote Active Ageing and Wellness Program Item Cibubur Cipayung Cantayan

A. Health 1 Health Physical dimension

- nutrition - exercise/walking - positive behavior - hygiene sanitation/bathing - routine check up and health care

2. Health and Emotional dimension -talking - hearing - relaxing - accepting - early detection of depression

3.Health & Intellectual dimension -reading facility -brain games facility - brain games -sharing knowledge/skill -internet facility

++ +++

++++-

+++--

-++++

+-+--

+----

-++++

++++-

+----

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Item Cibubur Cipayung Cantayan

4.Health & Social dimension- group activity/intergenerational- social gathering - helping others - gotong royong - community activity /cader,

committee in mosque/church 5. Health & Vocational dimension

- counter for display - accomplishing hobby - skill development- volunteerism

6. Health & Spiritual dimension- CIE on Religion - praying - appreciation to God creation+- gratefull

++---

+++-

++++

-++--

+++-

+++-

+++++

++++

++++

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Item Cibubur Cipayung Cantayan

B. Participation1. Participation & Physical dimension

- domestic participation- involving in community activity

2. Participation & Emotional dimension

- gathering - hobby development - sharing positive/negative

experience - hearing, learning and making

solution of elderly problems 3. Participation Intellectual dimension

-elderly empowerment in learning

and teaching activity - elderly empowerment in

management activity

--

++-

-

-

-

+-

-+-

-

-

-

++

++-

-

-

-

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Item Cibubur Cipayung Cantayan

4.Participation and Social dimension- appreciation each other - keep communication - appreciating to other people ideas - integration to environment -

5.Participation and Vocational dimension- accomplishing knowledge &

experience to remain active -- motivating elderly to sharing their

experience & kowledge in some activity -6. Participation and spiritual dimension

- active in community spiritual activity - assisting religion activity -- resource persons -- teaching and to be role model to

children or grand children +

-++-

-

-

+---+

+-+-

+

-

-+--+

++++

+

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+++++

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Item Cibubur Cipayung Cantayan

C. Security1. Security and Physical dimension

- fall prevention - violence and discrimination

prevention 2. Security and Emotional dimension

- not discrimination action - dignity action - improve family awareness to respect

and to fulfill elderly rights 3.Security and Intellectual dimension

- accessibility to library - accessibility to brain games

4. Security and Social dimension - accompany to social activity

5.Security and Vocational dimension- proper light - comfortable room - CIE on fall prevention

6.Security and Spiritual dimension - providing book and comfortable room - accompany to religion activity

++

++-

++

-

+++

++

-+

+--

+-

-

+++

++

-+

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Quality of Life

EQ-5D Cibubur n=35

Cipayungn=39

Cantayann=73

Total=147

LowHigh

n1223

%3.,365.7

n1326

%33.366.7

n568

%6.893.2

nt30117

%20.479.6

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Trend of Life Expectancy

70.93

71.51

71.91

72.1572.29

72.38

70.00

70.50

71.00

71.50

72.00

72.50

2010 2015 2020 2025 2030 2035

Sumber : BPS

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Older People Proportion by Province , 2012

Susenas 2012: BPS

1.94

3.17 3.

56 4.03

4.07 4.

62 4.71 4.78 5.

24 5.52 5.

80

5.83

5.83

5.83

5.86

5.88

5.89

5.90 5.98 6.20

6.23 6.31

7.05 7.21

7.23 7.44

8.09 8.

34 8.45

9.78 10

.34

10.4

0

13.0

4

0

2

4

6

8

10

12

14

Indonesia :7,56%

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70%

27.1%

2.9%

Light

Middle

Heavy

Level of Disability

Basic Health Survey, 2007

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Health Problems(Basic Health Survey 2013)

NO HEALTH PROBLEM

Prevalences on age groups

55-64 yr 65-74 yr 75 + yr

1 COPD 5,6 8,6 9,4

2 CANCER 3,2 3,9 5

3 DM 5,5 4,8 3,5

4 HYPERTENSION 45,9 57,6 63,8

5 CHD 2,8 3,6 3,2

6 HEART FAILURE 0,7 0,9 1,1

7 STROKE 33 46,1 67

8 RENAL FAILURE 0,5 0,5 0,6

9 KIDNEY STONE 1,3 1,2 1,1

10 ARTHRITIS 45 51,9 54,8

11MOUTH AND TEETH PROBLEMS 28,3 19,2 19,2

28

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DALY Reflects Burden Of Disease(BOD)

“ the DALY is a health gap measure that extends the concept of potential years of life lost due to premature death to include equivalent years of healthy life lost by virtue of individuals being in states of poor health or disability” (WS Evidence for Health Policy 2002, WHO GBD risk factor 2006, Abegunde D, Lancet 2007).

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INDONESIA BOD ( Burden of Disease) PREDICTION, 2010

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Collaboration in Grass Root Level

Family Care Support System by BKKBN local office , through care givers and or family planning staff

Primary Health Centers for health services and home nursing

Community care and home care services by Posyandu ( Community Integrated Posts)

Social care by NGOs supported by local office of Ministry of Social Affair

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Care Network of LTC in Yogyakarta

VOLUNTER

Sub village

Older person Family

Commuenity Volunteer

Small shopsPopulati

on and FP Field

staff

Commleader

Health center

Village-Subdist

rict

Red cross

Hospital

Institu

Ional Care

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Comprehensive teamwork ( Health Providers , Social Workers and Volunteers), Bangkalan , East Java

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Home care /Home Visits : 20 Families with Elderly provided by A Group of care givers ( family and volunteer),Surabaya, East Java

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Limitations

Coordination in National Level has not been done well

In local areas particularly in remote areas funding limitation is significant;

Limitation of knowlegde and skill of providers particulaly in LTC services

Limitation of Comprehensive LTC facilities The weakness of linkage and referral system

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Recommendation

Strengthening Comprehensive Community Care System

Training and distributing references materials

Mobilizing resources to fulfill facilities. Improving Coordination and Monitoring

System

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Polyclinic

Acute ward Chronic ward *

Day-care

Hospital-based

Home-care

PH Center Institutional Care *

Comm Day-care

Community-based

1. Discarge planning2. Care at home3. Home Health Nursing4. Promotive,Preventive

rehabilitative activities5. Informal care/family6. Paid by local

community and Community Health Insurance

7. Some personal care8. Domestic assistant 9. Profesional Care by

Health Providers10. Referral System :

family/home to PHC, and To Hospital

COMPREHENSIVECOMMUNITY CARE:

* No Chronic Ward and rare of Institutional care

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Topics and Method of Training for Health ProvidersLecture Topics: Communication technique Aging process and clinical implications Geriatric Syndrome Socio – economic problems Communication problem Comprehensive geriatric assessment (CGA) and care Nursing assessment and care for the elderly Common psychiatric problems and cognitive impairment in elderly Physical exercise and rehabilitation in the management of geriatric patients Nutritional status assessment Medication in elderly Oral care in the elderly Rehabilitation i Method:Lectures,Practical sessions in hospital and PHC,Case-discussions,Home-visit session

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Harmonization of Training across Countries( Braun, 2013)

Competencies for Entry-Level Care Workers in US

1.Health Promotion and Safety

2.Evaluation and Assessment

3.Care Planning and Coordination across the Care Spectrum

4.Interdisciplinary and Team Care

5.Caregiver Support

6.Healthcare Systems

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The Role of Academic Institutions Providing experts Providing materials based on research, case

findings, and other sources Providing longitudinal support through

academic program. Lesson learned from best practices to be

references in the development of curriculum Conducting collaborative research for

assessment, evaluation and development models

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Centre for Ageing Studies University of Indonesia

Age Concern Program at Centre for Ageing Studies (CAS) UI

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Conclusion

Cost-efficient, as services are provided at home by family and or local community.

Replicable: accepted by family and community and in line with Indonesian culture.

Sustainable, as services provided meets the need of the users and is provided by and for the community, and supported by local government and community health fund

Community care giving seems relatively better

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Acknowledgment

Asian Aging Business Center

Toyota Foundation

Kyushu University

University of Indonesia

University of Respati Yogyakarta

National Commission for Older Persons

National Board on Population and Family Planning

Ministry of Health

Ministry of Social affair

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Thank You