VISITING ANGELS NURSING AGENCY LTD TOWARDS FORMAL LTC SERVICE MODELS 2ND IAGG AFRICA REGION CONFERENCE 6TH - 8TH DECEMBER 2016

Introduction: Background A private limited company incorporated in 2012 Not a franchise Motivated mainly by the passion to start a business in nursing practice, with a previous experience of home-based care as a young girl growing up in the countryside.

Background… Visiting Angels opened its doors to help address increasing health needs and costs incurred in treating people with chronic and debilitating conditions in Nairobi, Kenya Has widened its scope to other parts of the country including Kisumu, Mombasa and Nyeri counties, to meet increased requests for assistance by more people and families, in care provision in their own homes.

Description of Broad service type In general, the package of services offered by Visiting Angels include home nursing, rehabilitation, personal care, day and night care, respite care, assistive devices.

General service types Package offered is: Home nursing; 12 hour shift or 24 hour shifts, house calls ( wound dressing, IV drug administration) General rehabilitative services Wound care

Specific service types Home based nursing care comprising personal care to compensate for functional limitations (mobility in the home, dressing, eating, toileting, escort to doctors’ appointments etc.); specialized home health care and services (medical care, nursing care

Specific service types… Physiotherapy, Occupational therapy nutritional advice and psychosocial services, and supervision of medication); accompanying client to social places, spiritual support services

Specific service types… Disease management program for older people – This aims to make early or timely diagnosis of potential conditions in the elderly clients. The program is run and managed by medical professionals who ensure that tests, investigations and medications are done and administered appropriately, that hospital and clinic visits are adhered to and that doctor’s instructions are abided by it.

Specific service types… Training of in-service nurses and patient attendants

Operation and scope The team consists of an administrative and care management team that supervises the care process as undertaken by staff that are expected to be available to provide clients with part time, full time or 24-hour live-in care as required.

Planning the services Patient attendants Patient Physiotherapy OT Nursing

Planning & management of care Initial assessments Develop an individualised care plan These include initial and ongoing assessment, planning, and management of care, organising shifts per patient and supervision of other services as carried out by the appropriate professional.

Financing Cash-paying clients Insured clients Must keep expenses / overheads very low

The provision of quality care In-depth assessments, caregiver introductions, ongoing supervision and care management. Involving the family in the care plan at the point of inception Continous supervisory visits and monitoring the care plan, review if required Progress reports to family and/or doctors on a monthly basis or as required.

Provision of quality care… The Agency has established an internal system of quality assurance, which includes:- supervision setting standards to ensure quality is sustained and enabling clients and families to provide feedback on the quality of their care (through specially designed questionnaires).

Providing integrated care Work with client’s family members and /or primary caregiver Home-based rehabilitation Internal communication; as in emergencies Family doctors- upon invitation by family Contract with emergency service providers Careful recruitment and allocation of staff ; certificates, police certificates of good conduct

Ensuring equity in access How do we determine client eligibility to care services? Mainly guided by the initial assessment plan.

Ensuring decent & fair working conditions for workers We have a pool of staff of all cadres Each staff signs a short term contract All report to the agency for the time they are working for us. Work in shifts to cover about 60 hours a week

How do families view LTC as relating to customary norms? Family carers are partners in the service to their loved one. These circumstances require a significant effort to guide, educate, and inform clients and their families. The broad commitment by Visiting Angels is to tailor services to individual and family needs.

Future sustainability of the service model Financing Some insurance companies buying into the idea of funding home based nursing care if the client has the relevant medical policy. The challenge is that many older people do not have health insurance policy and this affects sustainability because it means the Agency can only draw on a limited target market.

Future sustainability…. Workforce Some carers have opted out of Visiting Angels preferring to start up as individuals on a freelance basis so as to make more money, be free of supervision etc. but with the realization that working under the umbrella of the Agency is beneficial to them in terms of offering security from abuse, allowing flexible working hours, providing credibility etc. they have opted back in. It is envisaged that with an increase in client volume, the practice will be able to hire staff on a longer term or permanent basis. 

THANK YOU ASANTE SANA