In 2014, the Authority of Elderly Care in Oslo decided to use service design methodology to put the future user at the centre when developing a strategic roadmap for its services in 2025.
2. Current healthcare services are
not economically sustainable
in the future.
This future is already
upon us in 2017.
3. Demographic changes
Urbanisation
Non-sustainable
public expenses
Decreasing
volunteerism
Those who are sick
become sicker
Welfare technology
Smarter patients
MEGATRENDS
ECONOMIC
SITUATION
Reduced income
from oil
Low long-term
interest rates
Rich generation
of elders
Nursing homes
are costly
Digitalisation
Municipality 3.0
Competing for
competence
Private healtcare
providers
Loneliness
Public health
polarization
Multi cultural
Big data
Increased
expectations and
demands
4. The Nursing Home Agency (Sykehjemsetaten)
Norway's largest operator of nursing homes and the second biggest municipal
agency within the City of Oslo
• 4 short term care and rehabilitation
health houses
• 44 long-term nursing homes
• Professional Development and
Research
• Apprenticeship Training Office for
Health, Childhood and Youth Services
• 9,000 residents and patients annually
• 1.6 million nights annually
• 12,000 employees
• 5 Billion NOK / 410 Million GBP annual
budget
8. Triggers for moving to a Nursing Home
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Non-disease dependent triggers
0
2
4
6
8
10
12
14
16
Average home care h/w
Oslo St.Hanshaugen
Economical triggers
Potential annual cost reduction -
923 MNOK
Threshold value: Nursing home > 15 h/w home care
10. Planning and facilitation
in addition to long-term
comprehensive efforts
Ownership
of inhabitant
Individual home
with a separation
between private and
public
Accurate, holistic efforts
towards common goals
Future care for the elderly will
provide early help to plan own
aging, facilitate different forms
of housing and provide
accurate care services at best
timing in each home,
customised the individual and
their holistic situation
15. 1. Predictable and smooth
transition
2. Accurate reception and
early clarification
3. Targeted stay
4. Safe and smooth
transition back home
1
2
34
1
2
3
4
17. • Facilitate a range of different
adapted properties
• All permanent locations are
a home
• All services available at all
locations
• The 24/7 nursing home is
a home equal to other
homes.
• 24/7 consist of a range of
different forms of living.
• 24/7 are flexible in degree
and level of services
Original home
Property with a
life-long standard
Care homes
24/7-offering
21. INNSATS OG EFFEKTVURDERING
BRUKER
MÅNED 1 2 3 4 5 6 7 8 9 10 11 12
ROLLE FORLØP KR/TIME
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33 0,33
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP 4 2
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP 1
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP 15 15 15 15 15 15 15 15 15 15 15 15
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP 2,5 1,5 1 1 1 1
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP
STANDARD FORLØP
IDEELT FORLØP 0,5
STANDARD FORLØP
IDEELT FORLØP 0,5 0,5
STANDARD FORLØP
2010
HELSEHUS 2 000
DAGSENTER 105000
267
267
0
EKSTRAORDINÆR LEGE (HELSEHUS) 440
250
250
240
EKSTRAORDINÆR FYSIOTERAPEUT (HELSEHUS)
EKSTRAORDINÆR ERGOTERAPEUT (HELSEHUS)
EKSTRAORDINÆR SYKEPLEIER (HELSEHUS)
215
INNSATSTEAM
FYSIO/ERGO FAGKONSULENT (H.REHAB.)
237
250
250
250
HJEMMETRENER (H.REHAB.)
STUDENT/LÆRLING/ELEV
SENIORSENTER OG ANDRE ELDRE TJENESTER
NAV
BESTILLERKONTOR
RUS OG PSYKIATRI
ASYL
BARN OG UNGE
ØKONOMISK RÅDGIVNING
DEMENSTEAM
EKSTRAORDINÆR HJELPEPLEIER (HELSEHUS)
HJEMMESYKEPLEIE
PSYKISK HELSEARBEIDER
PRAKTISK BISTAND/HJEMMEHJELP
HJELPEARBEIDER/HELSEFAGARBEIDER
559
267
435
435
250
250
22. Case Description
Female, 70 years
If the city of Oslo had invested accurate
and timely from first contact
in 2013, they would have saved
1,850,000 NOK
by 2018
-1000000
-800000
-600000
-400000
-200000
0
200000
400000
600000
800000
1000000
2010 2011 2012 2013 2014 2015 2016 2017 2018
IDEAL STANDARD DIFFERENCE
- 1 850 000
0
500000
1000000
1500000
2000000
2500000
IDEAL STANDARD
23. Case Summary
1. Male, 84: - 1
450 000
2. Female, 40: - 200
000
3. Male, 75: -
900 000
4. Female, 70: - 1 850
000
5. Male, 79: + 600
000
Total cost reduction for entire period:
3,750,000 NOK
Average cost reduction per year:
- 3 750 000
# users in Oslo municipality > 67: 20% = 12 600
# users in Oslo municipality < 67: 0,5% = 2 700
# users interdisciplinary assessment: 50%
Estimated annual cost reduction:
880 MNOK
-
1000 000
2000 000
3000 000
4000 000
5000 000
6000 000
7000 000
8000 000
STANDARD IDEAL
Thank you for coming.
Our names and where we come from
A provocation to catch the audience
The present situation
The current organization of elderly care in Oslo is not sustainable in the future
The population is increasing and the population is aging:
The population of Oslo is growing; Oslo is actually the fastest growing city in Europe in percentage of existing population. Meanwhile, improved public health and life expectancy increases.
But we know that with longer life expectancy the incidence of illness and injuries will also increase. Population trends tell us that by 2040, Oslo will double the number of residents over 67 years.
A corresponding increase in the services provided to the aging population will therefore not be sustainable in the future.
Nor will it be enough health workers available to meet such needs and demands.
The services provided today appears, seen from the citizens point of view, as fragmented and complex.
To succeed, it is necessary with an innovative approach to the organization of health and social services, and moreover also the coordination of use of resources.
Tomorrow's users will have higher expectations and demands of services
Oslo's inhabitants will have completely different requirements and expectations for services in the future than what we see with today's residents of nursing homes.
For example, the expectation being that also the last phase of life should be in an environment which is a personal home with the rights it entails ‐ and not an institution where the services are largely directed in relation to the part of life that is being a patient, as it is today.
Another important expectation for the future is that the elderly must not move when the need of health care changes which is the reality in Oslo today.
Decreasing government revenues
Elderly care in Norway:
Health and social care sector is publicly financed. And health care services are organized in primary care (municipalities) and secondary/specialized care (hospitals). The municipality is responsible for home care services and institutionalized care.
Oslo municipality has in recent years increased their number of nursing homes and as a consequence a more comprehensive coverage than the rest of the country.
You may have heard about the Norwegian Petroleum fund which is now called the Government pension fund global, which is one of the largest pension funds in the world. This fund derives its financial backing from taxes from oil profits and invests the money, mostly in stock contributions and it`s meant to guarantee Norways citizens' prosperity for decades to come.
The problem is that Norway's oil revenues, on which we have been living quite comfortably for a long time, will decrease in the future. Already now we see these tendencies and the consequence is that in the future there will be less public revenue to pay for elderly care.
So the future elderly in Norway must take more responsibility for their own appearing old age
Population of Norway: 5 million
Population of Oslo: 620 000
Population of larger Oslo: 900 000
The population 67 and above will increase from 22%/620 000 (2015) to 30%/780 000 (2030)
Pensionexpenses will increase from 120 MRNOK/ 10 BGBP (2015) to 190 MNOK / 16 BGBP (2030)
The expectation and demand among elders is increasing
First a few words about my organisation, Sykehjemsetaten; The Nursing home Agency in The City of Oslo.
Health houses have competence to safeguard patients discharged from hospitals, and also people living at home who are in need of good medical service, rehabilitation and training in daily life skills. The aim is that patients are going home after their stay in a health house.
The nursing homes are long‐term housing, health and care services for those who can no longer stay at home. The aim is that there should be continuity and a homely atmosphere, and that it should be organized in such a way that they can maintain everyday life activities as far as possible in line with the individual residents preferences.
Municipal nursing homes
17 long-term nursing homes
3 health houses
Private nursing homes
13 long-term nursing homes operated by non-profit providers
14 long-term nursing homes operated by commercial providers
1 health house operated by a commercial provider
The Agency also purchases individual places at four nursing homes outside Oslo
Residents and patients
The long-term nursing homes house 3900 residents. The average stay is approximately 2.1 years
4500 patients go for short-term and rehabilitation stays at the health house annualy. The average stay is approximately 3 weeks.
Overall objective of the project
The main focus is that older people in Oslo shall be able to live independently, active and secure lives and stay healthy as long as possible.
The overall objective of our project is therefore that Oslo's population will live in their own homes as long as possible with a good quality of life and cope with everyday life with minimal publicly funded services.
Project Background:
The project started in 2014 by decision of the Department of Health, Seniors and Social Affairs. 4 regional health houses would be established in the City of Oslo. The Nursing home Agency was commissioned to implement this in collaboration with the 15 Districts of Oslo. This was a major adjustment for The Nursing home Agency where a total of 24 nursing homes had to change operational model.
And I was lucky enough to be asked if I could lead this major change project in The Nursing home Agency.
And in the course of 2015, we established 4 health houses while the other 40 nursing homes were changed to long‐term establishments. 450 patients and 450 employees moved as a result of the establishment of health houses.
But when we started this change project in 2014, I wanted to use this opportunity to lift the ambition level, rethink and develop new service models with an eye for tomorrow's challenges and solutions for tomorrow's users.
Election of innovation tools
With high ambitions, long‐term and innovative look we thought that future solutions should be based on user needs and perspectives if we should succeed. The intention was then to identify and describe the good user experiences and show how they can be delivered in 2025.
With this focus on user experience, it was quite obvious to choose service design as a tool for innovation. We chose to involve a Design and Architecture firm that could assist us with this project. And this led to a partnership with Livework that started in November 2014.
The assignment (Scope)
1. How can we organize housing, health and care services so that seniors who need live‐in care, feel that they have a good last home? = "My home" (long term care – nursing home)
2. How can seniors live as long as possible in their own home, with the best possible support for rehabilitation and self-sufficiency, so that their needs are met while service provisions are getting more efficient?
• Rehabilitation and self-sufficiency services at home
• Health house
INSIGHTS
TREATMENT AND CARE:
The mandate and reason d’aitre for the whole organisation is proper treatment, nursing and care. This is why they are in contact in the first place.
PREVENT:
«We should probably consider it, but we will probably wait and see…»
Help me to plan my older days
”We must teach people that they grow old.”
Loneliness and depression is often the actual reason
CAPTURE
Difficult to catch the disadvantaged
«This is not people that book an appointment themselves…»
LONG TERM
Short term = costly
«The trend is high quality single services. But the services are isolated …»
COMPREHENSIVE
Need coordination between the high quality isolated services, seeing the entire user, including their life situation and relatives, not only treating the desease and symptoms
No one see the patient 360 degrees
«We coudl rehabilitate the leg, but the issue is the abuse problem…»
«Who´s got the responsibility to ensure entirety across the services? »
Lack of data sharing across – dysfunctional confidentiality
Lack of common platform across services.
ENSURE VALUE
Speed and timing = increased chance of good results
«Window of opportunity for rehabilitation is limited, and it is a challenge to get started as early as requested…»
Common target across services
«The common target must be in accordance with the patient… »
HOME
No one wants to leave their own home, they want to remain there and hopefuly die there
A well functioning home must provide the experience of safety and security
Non desease dependent triggers for nursing home seats: living alone, need of help to exit, weary relatives, lack of network, lonelisness, not adapted housing, nutrition failure
Key drivers to achieve goal
Planned aging
Experienced feeling of safe and secure
Accurate services at accurate timing
Threshold value: nursing home >15 h/w home care. Average for users in Oslo is 3,7 h/w.
Cost reduction potential for bringing it up to 4,7 h/w is 920 MNOK / 75 MGBP. Not full cost reduction due to increased services at home. Potential up to 15 h/w is enourmous
Potensialet for kostnadsreduksjon ved å øke t/u til St. Hanshaugen-standard for hele Oslo kommune er 923 MNOK, men en vesentlig del må investeres i utvidet hjemmetjenester.
Antall risikofaktorer pr. pasient er i snitt 7 (2-13).
Data basert på et tilfeldig uttrekk av 97 brukere i BFR, BNO, BOS
What are the key solutions to help people living longer at home?
Future elderly care will provide early help to plan own aging, provide different forms of housing and accurate services and care in own home, independent of where, customised the individual and their situation
We made a short film to describe the services and experiences that we would like the inhabitants to have in the future
9 principles for delivering elderly care. The principles are answering the key insights and needs that are mapped out for inhabitants, users, patients and their relatives, considering the economical and organisational aspect:
Facilitate – Advise me so that I can be prepared and avoid potential problems
Intercept – Discover when something goes wrong and make sure that it gets addressed
Predictability – Make the road ahead clear. Help me to understand what is going to happen and why.
Important to me – Understand my situation and focus on what is important to me
Holistic – Make sure that all the services I experience make sense together
Early efforts – Be willing to use resources on me early on, so that I got the most out of the treatment
Motivation – Support and motivate me, so that I can do most of it myself
Caretakers – help those who are close to me so that it is easier for them to give good support
Human – Treating users as human beings, not as assignments or tasks
Predictable and smooth transitionEarly, clear and precise informationSmooth cooperation between institutions and services at transition of patient.
Accurate reception and swift clarificationWarm and informative welcome on the reason and content of the stay
Common strategy for patient based on needs and target. Established through interdisciplinary cooperation across services
Targeted stayStay is targeted and all invovled work along to ensure that the patient reaches his or her goals. Activities and offering are directed to motivate and build competence for patients and relatives at home. Patient and relatives receive guidance and advisory to improve life at home.
Safe and smooth transition home
The life and total condition of the patient and relatives are mapped befreo transition to own home, and a follow up plan is defined across services and activities.
You will in 2025 live in your own home independent of need, situation and form of living
A range of different adapted properties are facilitated
All permanent locations are home
All services available at all locations
24/7 offering is a home equal to other homes.
24/7 consists of a range of different forms of living
24/7 offering are flexible on degree and level of services
The 24/7 nursing home offering must address two issues:
Being sick and getting proper health and care services
Living in a home
In all cases the user is living in their own home
A relevant every day for each inhabitant
Involve relatives
Flexible in terms of change in needs of inhabitant
Themes adapted to groups of users
Common arearepresent society
Tilbakemeldingene etter pilotene viste at velkomsten og oppstartsamtalen var tiltak som fungerte svært godt og hadde den effekten vi var på jakt etter.
Rådgivningsmøtet og avsluttende møte ble i mindre grad gjennomført. Til dels på grunn av opplevelsen av at man dekket det meste i det første møtet, til dels pga. tidspress og gjennomføringsevne i piloten.
Det tverrfaglige møtet var hovedsakelig på tvers av helse og omsorg, og representerte i begrenset grad alle områder av pasientens liv og mulige behov.
Piloting and business as usual is demanding
A pilot may need several takes
Solutions may demand slide in time
Balance the utopia and pragmatic solutions
Design for people that are sufficiently sick
Road from vision to start implementation is long