Elderly Care Cost Control using Observation, Assessment, and Decision-Making

Elderly Care Cost Control using Observation, Assessment, and Decision-Making

Patrik Eklund (Umeå University, Sweden)
DOI: 10.4018/978-1-4666-3986-7.ch016
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Municipal and regional best practices for strategic planning and management of ageing is achieved by developing accurate socio-economic modelling tools based on rigorous design of information and processes. Demographic models enable analysis and prediction of demographic change, and socio-economic modelling, based on ageing information and process design, is sensitive and specific in particular concerning variables related to demographic change. Service forms based on observation, assessment, and decision-making are typically used in home care, adult day care centres, residential care, nursing homes, and/or wards. The suggested approach to socio-economic modelling-based strategic planning is both customer-centric with respect to information and process design as well as care-centric with respect to care management.
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Observe-Assess-Decide (Oad)


The cost of elderly care is inevitably increasing, and financing models must adapt accordingly. Financing sources are basically central and local government, social security funds and insurance, and even out-of-pocket financing. Public financing relying mostly on central and local government are still the cornerstones in Northern European countries, whereas a mixture between, on the one hand, central and local government, and, on the other hand, social security funds and insurance, is adopted elsewhere in Europe. As private stakeholders enter the scene, finding the balance becomes strategically more and more important, regardless of respective financing priorities.

Elderly care also in East Asia is more and more in focus. In Korea, the new system of long-term care insurance for the elderly, which has chosen the route of national solidarity to fund the system, clearly needs to be considered in the decision-making dimension of assessment scales. The cost of elderly care is inevitably increasing, and financing models must adapt accordingly. In Korea, social security is increasing rapidly, and out-of-pocket financing diminishes correspondingly. This implies a shift of OAD customer focus from individual to society, and further from municipality to region/area. Elderly care and OAD usage happens in municipalities, but the monitoring of it all happens typically on regional level, and thus the customer is the region, whereas the municipality becomes the customer of the region. This is very important in answering the question ‘Who pays, for what, and why?’. The long-term care insurance system in Japan clearly shows the need for socio-economic modelling based on demographic change analysis. Elderly care is managed on national, prefectural and city level. Laws and regulations, and care insurance scheme are all in the picture. Community care usually has an own system of assessments which is a basis for regular reporting.

Care cost and labour cost are fairly easy to calculate, but their distribution over the changing picture of health conditions, including function decline and the increasing problems related to cognitive disorders, are non-trivial. This is mostly due to fact that monitoring of demographic change and medical condition based function decline is not organized systematically, and therefore, there is basically no socio-economical framework into which cost-related structures can be mapped.

Key Terms in this Chapter

Early Detection: And prevention of various kind is key in all elderly care, and also in dementia care. Early detection e.g. of Alzheimer’s disease enables pharmacologic interventions with cholinesterase inhibitors.

Ageing and Older Persons: Refers here to individuals already in at least a mild stage of cognitive and function decline, i.e. individuals that require at least some form of home care services for living in their own homes. Decline being moderate to severe means that the individual is in some form of residential home or even in a hospital ward.

Home Care: Covers a wide range of health and social care services provided to older persons living in their home environments.

Assessment Scales: Are typically questionnaires or scales at least covering areas like dementia, including both cognitive as well as non-cognitive aspects, depression, ADL, nutrition, substance-related and quality of life. The challenge is how to provide overall assessments given particular information in these areas, and finally, to provide decision-making on care levels and interventions based on these assessments.

Dementia: Is a syndrome, and it is common to speak both of types of dementia and causes of dementia. Type and cause both represent disease or diagnosis. The most common type of dementia is the Alzheimer’s disease (AD). Lewy body dementia (LBD) is also quite frequently occurring, as is vascular dementia. Vascular dementia in turn is classified based on the underlying vascular disease, so there is a further differentiation, e.g. between post-stroke dementia, multi-infarct dementia and subcortical vascular dementia.

Social Record: Is yet to be defined but is seen as the complement, with some overlap, to the medical record, or the patient record. Assessment scale data is typically included mostly in the social record.

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