presented in harmonization of standard of long term care ... · posyandu lansia 2. elderly home...
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Presented inHarmonization of Standard of Long Term Care
Jakarta, 18 February 2014
• One of the goals of health development is increasing lifeexpectancy from 70,6 years in 2010 to 72 years in 2014
• Today, Indonesia is one of the five countries with the most ageingpopulation
• In 2010 (Population Sencuss) : Number of Older Population are 18,1• In 2010 (Population Sencuss) : Number of Older Population are 18,1Millions (7,6% of total population)
• Number of older population 60+ years is projected to increasefrom 18.1 M to 29.1 M in 2020 and 36 M in 2025
• Post-war baby boom in 1960-1970 aged-population boom 60years later ( 2020 – 2030)
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DISTRIBUTION OF OLDER POPULATION BY PROVINCES
Indonesia :7,56%
Susenas 2012: BPS
Elderly Health Problems(Basic Health Research 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 3,53 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
11 MOUTH AND TEETH PROBLEMS 28,3 19,2 19,2
12 MENTAL DISORDER ? 4
Policy on Healthy Ageing
General Objective :To increase older health status so the elderly will live longer,remain happy, healthy, productive and independent
Specific objective :• To increase awareness of ageing to promote older health status• To increase awareness of ageing to promote older health status• To increase the capacity and awareness of families and community
to promote and maintain health in old age• To increase acces and provide quality health services for the older
persons• To increase coordination with related programs, related sectors,
NGO to promote healthy ageing
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POLICY
• Facilitating in provision of older person health aspart of family health efforts , through primaryhealth and referrals
• Implemented through holistic approach with focuson social and local cultural valueson social and local cultural values
• Implemented by increasing integration of interprogram and related sector approach
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CONTINUE…………………………………
• Promotion and prevention is implementedcomprehensively with curative and rehabilitativeefforts
• Increase community participation includes privatesector and older person participation based onsector and older person participation based onmutual assistance and guidance by the Central andProvincial Governments
• Older Health Services provision based onstablished quality control and assurancemechanisms at every level of service.
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HEALTH PROGRAM FOR ELDERLY
1. INCREASE AND IMPROVEOLDER HEALTH SERVICES INPRIMARY HEALTH SERVICE
AGE FRIENDLY
PRIMARY HEALTH CARE
2. INCREASING HEALTHREFERRALS FOR ELDERLY
GERIATRIC CLINIC INHOSPITAL
3. PROMOTION & IEC FOR OLDER PERSONS.3. PROMOTION & IEC FOR OLDER PERSONS.
4. HOME CARE FOR ELDERLY AND FAMILY.
6. DEVELOPMENT OF INSTITUTIONS FOR ELDERLY CARE
5. INCREASE COMMUNITY EMPOWERMENT THROUGHELDERLY GROUPS.
AGE FRIENDLY PHC
PHC that gave comprehensivePHC that gave comprehensivehealth services for elderly :health services for elderly :-- Priority for promotive andPriority for promotive andpreventivepreventive
-- CurativeCurative-- RehabilitativeRehabilitative
The Services must beThe Services must beProPro--activeactiveAccessibleAccessibleProfessional personnels whoProfessional personnels who
have been trained and base onhave been trained and base onstandard of servicesstandard of services
Principle for elderly health services in PHC
1. Providing good service, quality and courteous.
2. Provide ease of service to the elderly in the provision of asafe and easily accessible.
3. Provide support / guidance to the elderly in maintaining andimproving health, in order to remain healthy, independent andactive.
4. Doing service is pro-active in order to reach as many target4. Doing service is pro-active in order to reach as many targetelderly in Puskesmas through service activities outside thebuilding.
5. To coordination the program across the life cycle approachas one approach to reach healthy and active aging
6. Cooperating with other sector, including civil societyorganizations and the business community with the principleof partnership, to do service and guidance in order toimprove the quality of life for elderlyIndonesian Presentation 10
ACTIVITIES OF THE AGE FRIENDLY PHC
1. Promotive
a. Counseling;
b. Physical and mental exercise, and
c. Other efforts to encourage the growth of the communityempowerment for the elderly health care
2. Preventive
a. Early detection and early interventiona. Early detection and early intervention
b. Counseling,
3. Curative
a. Treatment;
b. Nursing care
c. Counseling, and
d. Referral.
4. Rehabilitative
a. Physical rehabilitation
b. Phsycosocial rehabilitation
Outreach servisces include :Promotive, preventive,
curative, and Rehabilitative,
Implemented in:
1. Integrated health care for elderly (Elderly Groups)1. Integrated health care for elderly (Elderly Groups) Posyandu lansia
2. Elderly home care
3. Services in nursing home for elderly (panti lansia)
4. Elderly other group located in the Puskesmas area
ELDERLY HEALTH CAREMANAGEMENT IN PHC
The activities starting from:-Comprehensive geriatric assessment,-Physical examination,-Investigation,-Diagnosis-Diagnosis-Treatment
In Puskesmas, Comprehensive geriatric assessment can bedone by a doctor, nurse, nutrition personnel, physicaltherapist and / or other health professionals to manageelderly patients according to their respective competenceled by doctors
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RESOURCES
• Human resources- doctors
- Dentist/dental nurse
- Nurses
- Nutritionist- Nutritionist
- Public health
• Infrastructure: accessible and safety forthe elderly
• Availability of drugs for the elderly
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OUTREACH SERVICES
1. Elderly Groups (Posyandu lansia)– Provides services for elderly in the community– Representing community participation in terms of facilitation of
older health maintenance– Activities focus on promotion and prevention– Design of activities for example: periodic health examination,– Design of activities for example: periodic health examination,
counseling, religious activity, exercise or other social activities
– Elderly participants are provided with monitoring book to monitorthemselves and health cards (KMS)
– Activity of Elderly Group is facilitated by health volunteer oftenelderly themselves
– Cadre come from the community, they are volunteers and trainedin basic gerontology
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2. Elderly Home Care- Continuing of acute care in hospital- To maintenance and treatment- Comprehensive services (promotive, preventive,
curative and rehabuilitative)- Holistic services (physic, phsycologic, social and
spritual)- Assessment of functional status- Assessment of functional status- Kind of services:
- To increase mobilitation- Use of mobile devices- Used of drugs- Management of Phsyciatry problem- Nutritional optimal (balance)- Social support
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3. Nursing Home (panti)
PHC have panti in its area must visit minimal 1x/ month
Activities in panti:
Social campaigne
Physical exercise
Health exemination for early detectionHealth exemination for early detection
Simple laboratoryum
Treatment
Counceling
Referral
Indonesian Presentation 17
LONG TERM CARE
LTC is a system of activities undertaken byinformal caregivers (family, friends, and/orneighbours),and/or professionals (health, social,and others) to ensure that a person who is notfully capable of self-care can maintain thefully capable of self-care can maintain thehighest possible quality of life, according to hisor her individual preferences, with the greatestpossible degree of independence, autonomy,participation, personal fulfillment, and humandignity
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FRAMEWORK OF LONG TERM CAREMECHANISME
Indonesia Country report on LTC
IMPLEMENTING OF LTC
• In PHC: Can be part of Home Health Nursing (HomeCare) Directorate of Nursing
• In institutions (hospital, etc) : need to concidermany factors ( bulding, infrastructure, humanresources, funding, etc)
Gov. must arrange and provide welfare to the• Gov. must arrange and provide welfare to theelderly.
• Role of local administrations to support and providepublic services.
• Need training for human resources giving theservices for long term care (health worker, socialworker/care giver, etc )
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LTC PROJECT IN TAHILAND
Started in 2010 by the Department of Health as a planof the DoH.
• The National Committee on Elderly Persons and sub-committee launched LTC issue by setting upimplementation plan and indicated responsibleorganizations to implement the plan from 2011 to 2013organizations to implement the plan from 2011 to 2013
Model Tambol on Long-term care is indicator of theproject.
Concept: Integration of services (health and socialservices) by multidisciplinary approaches fordependent elderly persons in community to have goodquality of life and maintain their dignity.
21Thailand presentation
6 Criteria of Model Tambol on Long-term care
1. Having quality elderly club.
2. Having elderly data classified into 3 groupsaccording to ADL assessment.
3. Having volunteer to take care of the elderly incommunity.community.
4. Having good system of Home Health Care
5. Having system to take care of elderly group
6. Having dental health promotion andprevention in sub-district.
Thailand presentation
Elderly person
family
community
Local Administration
- Dependent/Family dep./Community dep.
- Family volunteer (FV.)
- Multipurpose center- Rehabilitation center- HV./ECV./physical therapy
- Nursing homesNGOs/
LTC Services
Local Administration
Province
Central Admin.
MoPH
- Nursing homes- Nurses/Caregivers- care manager
-M&E /Support/promote-Standard control
- 1° , 2° , 3° care- Excellent center- Home health care team.- care manager
- Policy/Laws/Standards
MoSD&HS
NGOs/Private S.
Thailand presentation
Success factors
LTC for dependent elderly was set as policy at all levels. Cooperation of all sectors involves at each level and across level;
– MoPH : PHO, district and sub-district hosp.,– MoSD&HS,– Senior Council Association of Thailand,– Local Adminstrations,– Volunteer: HV, ECV, SCV, E club V.– Health promoting temple– Health promoting temple– Thai Health,– National Health Security Office– Sub-district fund,– NGOs
• Monitoring and evaluation• Recognition and enforcement: Rewards to prominent
MTLTC• Promotion of exchange experiences through provincial,
regional and national level.Thailand presentation
Indonesian Presentation 25