Realities of health and formal long-term care integration International Association of Gerontology and Geriatrics 2ND Africa Region Conference 6-8 December 2016 Nairobi, Kenya Dr. Muthoni Gichu Ministry of Health, Kenya

Health changes may be unexpected! No one plans to have their health change or wants to admit they might need long term care someday. Marlene S. Stum, Ph.D. Family Economics and Gerontology. 2012.

Long-Term Care Help with activities of daily living (ADLs) and remaining independent Eating, bathing, dressing, transferring, walking, toileting, taking medications, shopping Wide range of services (personal, social, and medical) Variety of settings (in-home, community, assisted living, and skilled nursing facility) Marlene S. Stum, Ph.D. Family Economics and Gerontology. 2012.

Framework The Constitution of Kenya 2010 provides the overarching legal framework to ensure a comprehensive rights-based approach to health services delivery It provides that every person has a right to the highest attainable standard of health The Constitution of Kenya 2010 provides the overarching legal framework to ensure a comprehensive rights-based approach to health services delivery. It provides that every person has a right to the highest attainable standard of health, which includes reproductive health rights. It further states that a person shall not be denied emergency medical treatment and that the State shall provide appropriate social security to persons who are unable to support themselves and their dependants

According to the Vision 2030, priority will be given to the community and household level through a decentralized national health care system This is aided by the devolution of health services, ensuring that health service delivery gets close to all Kenyans

Ministry of health’s commitment to guaranteeing highest possible standards of health in Kenya The Kenya Health Policy 2012-2030- offers guidelines to ensure momentous improvement in the status of health in Kenya, in line with the provision of the new constitution of Kenya 2010, Vision 2030, and other global commitments ) The six lifecycle cohorts for which services are to be provided, as follows; i. Pregnancy and the newborn child (up to 28 days of age) ii. Early childhood (28 days to 5 years) iii. Late childhood (6 to 12 years) iv. Adolescence and youth (13 to 24 years) v. Adulthood (25 to 59 years) vi. Elderly (60 years and over)

lifecycle cohorts i. Pregnancy and the newborn child (up to 28 days of age) ii. Early childhood (28 days to 5 years) iii. Late childhood (6 to 12 years) iv. Adolescence and youth (13 to 24 years) v. Adulthood (25 to 59 years) vi. Elderly (60 years and over) The KHP clearly outlines The six lifecycle cohorts for which services are to be provided, as follows;

Explore future demographic trends policies to support family carers, long- term care workers, financing arrangements long-term care insurance value for investment in long-term care policies to support family carers, long-term care workers, financing arrangements, long-term care insurance, and getting better value for investment in long-term care.

Financing Long Term Care: Dilemmas and Decisions “We planned for a shorter and healthier retirement” “I never expected to live so long!” “If I avoid it . . . it won’t happen right!” “I think my health insurance will pay” Marlene S. Sturn Ph D. Family Economics and Gerontology. 2012

Characteristics of LT care Physical or mental, temporary or permanent Need based on functional disabilities Promotes or maintains health and independence in functional abilities and quality of life To enable us to die peacefully and with dignity Multiple services and multiple professions spanning broad spectrum Multifaceted Designed around unique needs of the individual Service can change over time

Who needs LTC Chronic – permanent or indefinite period of time Impaired – a decrease in or loss of ability to perform Disabled – short or long term; varies by age group Functional ability – person’s ability to perform the basic activities of daily living

Understanding demand for LTC Patient represent “mosaic of sub- segments” of the population. Often co- morbid conditions Services can be organized across dimensions of users Some users of LT care have significant differences from other users Patient represent “mosaic of sub-segments” of the population. Often co-morbid conditions – Projecting demand for lt care requires and understanding of definitions and subsets of the population with chronic illnesses, impairments, functional disabilities, and the potential growth of each subsegment based on potential advances in biomedical technology, pharm, and devices Services can be organized across dimensions of users – by demographic characteristics (elderly or children), by affinity (veterans), by disease or diagnosis (mental illness, HIV/AIDS), or impairment (blind/disabled) Some users of LT care have significant differences from other users – age characteristics, disability characteristics, etc.

Organisation of LTC Informal organization – most LT care is provided by family and friends Each community may be different regarding availability of services Ideal system – client oriented continuum of care.

Providers of LTC Hospitals Nursing homes (most private) Home health agencies Hospices (a number that are functional) Adult day service programs Housing organizations

Opportunities CHVs Draft Healthy Ageing Strategy Palliative care platform NHIF cover for older persons- package Capacity building CHVs- It is the community based at tier 1 of the health structure Palliative care- Which is now an existing platform in which awareness needs to be created NHIF- Cover for older persons who are on the social protection program, here we need to define a package for this group, this could be a beginning point Capacity building- 2nd Africa region conference pre-conference activities-introduction to geriatric medicine 2MDs and 4 nurses

Create a plan for your situation Financial goals and expectations Characteristics of family members Financial resources Human resources Geography Marlene S. Sturn. Ph D. Family Economics and Gerontology 2012.

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