1. Overview of Community Based Care
Session 5/13c
Overview of Community Based Care
for Older Persons
Tran Bich Thuy, Country Director,
HelpAge International in Vietnam

2. Two key definitions:
Long term care is the activities undertaken by others to ensure that people with or at risk of a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity (WHO, 2015)
Community based care refers to all forms of care that do not require an older person to reside permanently in an institutional setting (hospital, residential care). This includes informal and formal care provided by families, friends/neighbors, domestic workers, community-groups, NGOs, private sector and public sector (WHO, 2015)

3. How to fill the growing care gap?
Session 5/13c
How to fill the growing care gap?
You might be familiar with the Wider Determinants of Health model which this is loosely based on – it highlights the areas (policy areas?) which influence the older person (and the care they receive). Typically these factors are outside of the older person’s control but can still be responsible for significant burden.

4. Key elements of care To prevent and manage ill health
Session 5/13c
Key elements of care
To prevent and manage ill health
and enhance functionality
Daily functioning
Age friendly environments
Income security
Participation, emotional and mental wellbeing
Life long prevention

5. Types of services Nursing Occupational therapy Rehabilitation
Vaccinations
Medication reviews
Self care education
Nutrition
Palliative care
Personal care
Home help (housework)
Home modifications
Meal services
Shopping services
Paying bills
Assistance with communication
Assistance with medication
Counselling
Befriending
Accompaniment (shopping, clinics, place of worship)
Group activities….

6. Modalities/ location

7. Global trends of long term care
Overall, it is moving:
From institutionalization to ageing in place. Over the past ten years in OECD countries the proportion of older people receiving home and community based care has generally increased.  
From fragmented health and social systems to integrated (or coordinated care)
Case management: one goal, one assessment, one care plan
Comprehensive coordinated and personalized care plans encompassing holistic needs
Overseen by care coordinators or care managers, supported by multi disciplinary teams
Continuum of care between primary, secondary and tertiary health providers
From older people being as passive and dependent to elderly who are engaged and supported

8. Why community based care?
Supports ageing in place which is the preference of most older people
Supports functional ability by engaging the care recipient as active in their lives and in their care to the extent possible
Usually more cost efficient for both the State and the individual/household
Improves accessibility by providing services where people live
Supports the family care givers can improve their labour force participation, quality of their lives, and quality of care they provide
Maximising use of local human resources providing jobs, engaging volunteers and the like

9. Elements for successful community-based care provision
Integrated into an overall care system with stewardship by national government
Single point of entry and integrated care allowing ease of navigation to needed services and ease of access for older people with care needs and their informal care support
Human resources development of the care workforce
Quality management of the various providers
Financing
Enabling environment - to support the care recipient and carers to achieve optimal functional ability (housing, transport, social participation, built environment, employment and education)

10. Session 5/13c
Role of the government
Collaboration required from public & private and non profit & civil society sectors
Governments: lead, mandate and facilitate
Strategy design and policy development
Facilitate and promote coordination
Financial commitment and strategy
Human resource development
Promote quality: minimum standards and guidelines, protocols, monitoring outcomes
Ensure protection
Facilitate entry of service providers
Focus supportive environments

11. Japan

12. Japan’s Integrated Community Care System
Benefit package:
healthcare
long-term care
preventative long term care
housing
livelihood support in an integrated manner in communities

13. Community based organisation model: ROK-ASEAN LMICs
Session 5/13c
Community based organisation model: ROK-ASEAN LMICs
Target beneficiary
Older persons who are over 60 and under poverty line
Older persons who have difficulties in ADL & IADL and NCDs
Older persons who have insufficient caregiving supports
Benefits
Volunteer based home care services,
Paid home care services,
Living support services,
Health services,
Case management
Agency responsible for providing service:
NGO in collaboration with OPA
다음으로 CMV에서 진행할 재가사업의 개요를 소개할 것임
목적, 대상, 서비스유형, 서비스제공자는 다음과 같음

14. The ideal “Delivery System” of Community based service
Session 5/13c
The ideal “Delivery System” of Community based service
It is time to make a discussion. The topic of discussion is to design the ideal delivery system.

15. Community based organisation model
Strengths
Provides coverage in hard to reach areas (e.g. rural, where health system is weaker)
Mobilizes community human resources
Nested within sustainable CBO mechanism
Supports early part of care continuum- prevention, self- care, health behaviors
Holistic- other needs met (e.g. livelihood, prevention, DRR)
Weaknesses
Requires CBO- limited coverage in some countries
Not always integrated into primary health care or government services

16. Community based organisation Model
Opportunities
Facilitate link between individuals at community level and health and social services
Could be nested within government strategy/approach (e.g. Vietnam, Cambodia)
Threats
Financial sustainable for volunteer-based social care, but paid carer element may require external financing
Weak health systems can prevent referrals, NCD management, etc
Without external support- broad-based geographical coverage is unlikely

17. Policy recommendation
at regional level
Governments should play a more active role in supporting community-based care for older people
Governments should recognize and support the role of older people associations, NGOs and other community structures and civil society organisations.
Increased availability of health care services that address needs of older people with chronic illness.
Social and health care should be integrated.
More investment in prevention and social care by governments
NCDs including dementia and their impact should be explicitly included in governments’ age care related policies and strategies.

18. Policy recommendation
at regional level
Clear minimum standards, protocols and strong systems of monitoring and evaluation, and regulation should be put in place
Better data should be collected to facilitate evidence-based policy making
Increased cross-regional sharing of knowledge and lessons learned

19. Thank you More information: HelpAge International www.helpage.org