EUROPEAN PAPERS ON THE NEW WELFARE

1. Introduction

The demographic changes in the developed countries, which is leading to the so called ‘inversion of the demographic triangle’, will have a most dramatic impact on these societies. An increasing number of older citizens, with reduced physical and mental abilities and most often also with chronic and degenerative diseases, will need support in order to remain independent and ‘age in place’ in their homes. Independent living is an important target not only because it usually represents a strong wish of the older person, who wants to maintain a good quality of life, but also because it reduces the burden on hospitals and long term care facilities, which represent expensive care settings. ‘Ageing in place’ is an important element of a new strategy for increasing the quality of healthcare while keeping costs under control: moving from what Andy Grove, Chairman of Intel Corp., calls the ‘mainframe age’ of healthcare to a more distributed model, where each single house becomes a setting for preventing or managing diseases.
A fundamental issue in developing an ‘ageing in place’ strategy must consider the incidence of disabilities and diseases: caregivers have to face a complex challenge, where preserving a good health status is necessary in order to allow elderly citizens to remain independent.

Figure 1: Annual healthcare spending in Europe: US$ 570 Bln

Source: OECD, World Health Organization, Center for Disease Control USA, 2000 data

In most countries the organisation of social and health services is separate, but home care services are composed by social and healthcare element in a unique framework. In this article the technological framework necessary to support elderly citizens ageing in their homes will be presented.

2. The technology framework

Two key components make up the framework for tele-home care services:
• the Operations Centre,
• the E-Health backbone.
The operations centre is a call centre where skilled operators are constantly following elderly persons at home and offering increasingly complex services. A basic set of services are based on the communication between the centre and the citizen:
1. Tele-emergency: the person has an integrated microphone and panic button that allows the immediate contact to the centre, where the problem can be described verbally.
2. Tele-control: the operators call regularly the persons at home, checking their general condition and identifying possible social and health problems.

Figure 2: Basic Tele-care services: tele-emergency and tele-control

The simple panic button can be integrated with other environmental sensors, that allow the monitoring of dangerous situations and alarms: movement sensors allow the detection of falls or gas sensors can detect the presence of dangerous emissions from a kitchen or the presence of an excess of carbon monoxide in the house.
The operations centre can also become the key component to a more coordinated approach where common social and health care protocols are shared between the social service operators, the healthcare service operators, the family and the patient.

Nicola Pangher: PhD, Italtbs SpA, Padriciano 99, 34012 Trieste, Italy.

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