RESPITE ROMANIA

Designing Romania’s Assisted Living Infrastructure

1 ROMANIAQUICK FACTS

• Joined the EU in 2004• 8th largest country in EU• Population: 21.8 Million (2013)• PPP GDP = USD $271.4 B (2012)

• PPP GDP Per Capita = USD $12 700• Language: Romanian (91%) • Capital: Bucharest

2Fried et al, Frailty in Older Adults, J Gerontol A Biol Sci Med Sci 2001;56(3):M146-56

3Collard et al, Prevalence of frailty in community dwelling older persons: A systematic review, J Am Geriatri Soc; 2012;260(8):1487-1492

1Popa D, The Long-Term Care System for the Elderly in Romania, ENEPRI Research Report No 85, Jun 2010, p. 6

Total Population

ROMANIADEMOGRAPHIC

• More than 3.2 Million Romanianelders

• More than 300 000 Romanians arefrail elders

• The fraction of elders is increasing

• Frailty Definition2

>65 years

Frail + >65 years

21.8 Million

3.27 Million (15%)

320,000 (1.5%)

15% of population > 65 y (2010);

25% of population > 65 y (2035)1

10% of patients > 65 y = FRAIL3

weight loss exhaustion weakness slowness low physical activity

• Frail Elders need increased supports

1Popa D, The Long-Term Care System for the Elderly in Romania, ENEPRI Research Report No 85, Jun 2010, p. 6

2Residential Care Facilities 2009-2010 Catalogue No 83-237-X, Statistics Canada, Sept 2011.

3OECD (2012), Health at a Glance Europe 2012, OECD Publishing http:// dx.doi.org/10.1787/9789264183896-en

AnalysisNO BEDS IN THE SYSTEM

• The post-acute care sector is virtually non existent in Romania

• Romania - 2,250 people per bed

• Canada - 155 people per bed : 15x more

NO STAFF IN THE SYSTEM• 1 nurse per 252 people (2006)

• 1 physician per 428 people (2008)

Canada: 1 nurse per 95 people

EU Average: 1 nurse per 127 people3

Canada: 1 physician per 424 people

EU Average: 1 physician per 294 people

Population: 21.8 M Population: 31.8 M

9 300 Long-Term Care Beds1

440 Assisted Living Beds1

14 500 Day Program Slots1

204 000 LTC + Assisted Living Beds2

Post Acute Care Infrastructure: Supply and Demand

1 2

3

Insufficient Training

• Education for health disciplines (nursing, rehab, etc.) is being upgraded to EU Standards

Analysis

1

Lack of Interprofessional Collaboration

• There is no expectation by the system for disciplines to collaborate with each other

2

Incomplete Staff Lineup

• Most facilities have an incomplete lineup of staff (e.g. lack of geriatricians, rehab staff, therapeutic recreation, etc.)

3

Post Acute Care Infrastructure

WORKING HARDER

• More family members working Less ability to stay at home to manage elderly loved ones

Analysis

1

INCREASED PRESSURES

• Increasingly difficult to balance time between work, caregiver roles and personal life

• Most families lack professional training in caregiving

2

CAREGIVER BURNOUT

• Hard to sustain the physical and emotional demands of caregiving without a break

• Worsening isolation of elderly loved one and family

3

1

2PERSONAL

W O R K

CAREGIVER

3

Shifting Family Dynamics

Designing Romania’s Assisted Living Infrastructure

Building TOGETHER a STATE of THE ART RESPITE Facility

Building a model which will serve as a template for other RESPITE Facilities

Creating the expertize to enhance the ADL in Romania

Our Goals in ROMANIA:

Basic ADLs

Bathing

Grooming

Dressing

Feeding

Transferring

Bladder Control

Toileting

Ambulation

Bowel Control

Stair Climbing

Instrumental ADLs

Housekeeping

Accounting

Food Preparation

Shopping

Medication Use

Laundry

Telephone Use

Transportation

Assessing Functional Capacity for ADL (Assisted Daily Living)

Bathing

Dressing

Feeding

Transferring

Toileting

MedicationReminder

Medication Dispensing

% Patients needing

ADL assistance

10%15%

33%

46%64%

50%70%

Typical Patient Profile

3DAY PROGRAMS

• A day of supportive activities designed to enhance well being for frail elders “Day care for elders”

1RESIDENTIAL CARE

• Provide a home for vulnerable elders in a supervised environment• Provide professional care services for vulnerable elders with stable medical

problems• “Patient moves in”

2RESPITE CARE

• “Patient in for a short break”• Gives caregivers a rest - AND/OR• Allows the patient to recover from a medical illness

in a supervised environment

>30

day

s<

30 d

ays

1 d

ay

Proposed types of care

Discharge Process3

Day Programa

Respite CareProgram

b

Retirement Livingc

Activitiesa

Health Careb

Day-to-Day Livingc

Intake Process1

Programs2

Service Flows

SOCIAL and RECREATIONAL ACTIVITIES

Group Individual

Health Promotion Exercise

1

MEAL SERVICE

3 meals / day Snacks

Dining Room Setting

2

BASIC ADL ASSISTANCE

Eating Bathing Ambulation

Dressing Toileting

3

HEALTH CARE SERVICES

Medication Assistance Medical Follow up

4

COMMUNITY IADL ASSISTANCE

Shopping Assistance

Shuttle service to City Centre

5

HOUSEKEEPING SERVICE6

LAUNDRY SERVICE7

BEAUTY AND BARBER SERVICE8

UTILITIES MANAGEMENT

Heating Electrical

Water Telephone

Cable Internet

9

CHAPLAINCY SERVICE10

BAKERY / FARMER’S MARKET11

Services Offered

Municipal Support1

Federal Support2

€10 - 20 Million1

?Sale and LeasebackArrangement

2

100-unit Facility1

“Green Technologies”2

Age > 65 years1

Continent2

Medically Stable3

PA

TIE

NT

PE

CU

NIA

RY

PR

OP

ER

TY

PO

LIT

ICA

L

Parameters

Executive

Director

Business Officer

RN RecTx SW OT/PT

HCA/PSW

Volunteers

CooksKitchen

Aides

Dishwashers

Maintenance Security

Housekeeping

Laundry Aide

MD DDS SLP

Pharm Diet

Resident Council

Hairdresser

Clergy

Staffing

Huge Market1

Team Expertise2

STRENGTHS

WEAKNESSES

OPPORTUNITIES

THREATS

Political Access3

Financial Access4

Care Staff Expertise1

Trainability of CareStaff

1

World FinancialStability

2

Political Instability/Corruption

3

Become theStandard

1

First Mover Advantage

2

Care StaffAvailability

2

SWOT Analysis

POLICY & PROCEDURES

MEASURE PERFORMANCE

IMPROVE PERFORMANCE

Define Expectations1

Define Performance Assessment Tools2

Create Educational Resources3

“To Do List”