1. 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

2. 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

3. 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

4. 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

5. 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

6. Ministry of health’s commitment to guaranteeing highest possible standards of health in Kenya
The Kenya Health Policy 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)

7. 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;

8. 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.

9. 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

10. 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

11. 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

12. 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.

13. 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.

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

15. 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

16. 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.

17. Thank you