U-Carefor the elderly Implemenation ofa Comprehensive Living and Health Care Network Heng-Shuen Chen Department of Medical Informatics Department of Family Medicine National Taiwan University College of Medicine and University Hospital, Taipei, Taiwan
Han-Wei Zhang, Genmart Tech Co. Taipei, Taiwan Jin-Shin, Lai Department of Physical Medicine & Rehabilitation National Taiwan University College of Medicine and University Hospital, Taipei, Taiwan
Mei-Ju Su, Graduate Institute of Electronics Engineering, College of Electrical Engineering and Computer Science, National Taiwan University Taipei, Taiwan
Fei-Pei Lai Dept. of Computer Science & Information Engineering
National Taiwan University, Taipei, Taiwan
Tsung-Hsueh Tsai, Shih-Shung Teng, Caridinal Tien Hospital Young-Ho Branch, Taipei, Taiwan
Ching-Yu Chen Department of Family Medicine National Taiwan University College of Medicine and University Hospital, Taipei, Taiwa fertility rate fell from the highest record as 6 births per woman of childbearing age to the replacement level of 2.1 in 1983 and continued to fall further to 1.1 in 2006. It is estimated in 2015, Taiwan will become the so-called "aged society" which means over 14% of population are elderly people, and in 2030 we are going to face the "over-aged society" with over 20 % elderly people just as current situation in Japan. Because of low birth rate the old age dependency ratio will concurrently increase rapidly from 1 to 7 in 2006 to 1 to 3 or 1 to 2 in year 2030 which means the number of working age persons (age 15 - 64 years) to support each elderly decrease from 7 to 3 or 2. That would be an enormous burden for every family and society. Moreover, most elderly people have chronic illness and require Mroe,ms lel epehv hoi lns n eur
Abstract-Taiwan started to be an 'aging society' from 1993, and the aging process will progress more rapidly due to markedly decreased child birth in recent year. Facing very high old age dependency ratio as 1 to 2 in year 2030 which means every two working age persons (age 15 - 64 years) have to support one elderly people. That would be an enormous burden for every family and society. In this study a U-Care system was developed and implemented in a satellite city region of Taipei metropolitan area in Taiwan, to provide a comprehensive living and health care service network for the elderly. The u-Health research team
of National Taiwan University and Hospital collaborate with Cardinal Tien Hospital Young-Ho Branch, 17 primary care
doctors and two living care service provider partners to provide
integrated and continuous services for elderly people in home, community and institutional setting.
constant attention for their health condition including daily life care and necessary medical care[1]. In an Elderly Nutrition
and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT), there were 7700 of elderly people with one or more chronic diseases; the average number of disease is 1.4. The most prevalent disease was hypertension, followed by arthritis, cardiac disease and diabetes mellitus. In Taiwan most of the elderly people (740/O) prefer to live together with their children in a house, reside next door or neighborhood in the same
Keywords-ubiquitous healthcre; living care; long term care; elderly
I.
INTRODUCTION
apartment complex building. Only 24% prefer living alone or
A. Rapidly Aging Society in Taiwan According to the definition by WHO, Taiwan started to be an "aging society" from 1993 when the percentage of elderly people reached 700O. In 2006 there were 100% population of elderly people, and the aging process goes more rapidly due to the markedly decreased child birth in recent years. The total
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institution[2]. So obliviously an oriental society as in Taiwan, elderly still want to stay at home for the rest of their lives. A good long term care system can support an active and healthy aging process to fulfill the principle of aging in place go to
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and ensuring the wellness of elderly and the peace and harmony of society.
In this study, the u-Health research team of National Taiwan University and Hospital collaborate with Cardinal Tien Hospital Young-Ho Branch (CTH-YHB)[4], three community medical groups(CMG) comprised 17 primary care doctors, a retirement residence, a residential and nursing home, and two living care service provider companies Genmart Tech and Angel Art Gallery to develop a integrated and continuous living and health care solution for the elderly people,.
B. Problems ofLong term carefor the elderly Long term care has been more emphasized in recent years by both government and private sectors. Although favorable policy making, strategies formulation and numerous resource investments provide an environment to cultivate related innovative product and service industry, there were still a lot of problems left unresolved. On the other hand, there were also opportunities existed in many aspects in development of healthcare industry for the elderly. The major problems of long term care system of the elderly are as the following:
A. Subjects The elderly people receive living and health care in this program can be classified into to healthy elderly, chronic ill elderly, and disabled elderly. The provided services on the other hand are distributed according to markets such as institution, residence community, home, and other mixed type of setting. No matter what kind of service to be provided to any elderly people, it would be arranged in an integrated, optimized and customized form to fulfill the needs of each individual.
1) Lacking home and community-oriented care resources. Starting from 1998 the long term care policy emphasized resource development more on community than institution. However it was not until 2004 that home living care became a significant service industry. Variable home care services model in the community should be developed to provide to different groups of the elderly people including physical handicapped, psychological handicapped, or dementia people according to their specific needs. 2) Poor linkages among multidisciplinary care resources. For the last 10 years, long term care service resources provided by different government sectors or private organizations were developed independently according to their respective goals and objectives. Most of them provided their services directly to the users, and they were not related or wellAs the elderly frequently have multiple chronic linked. illnesses, and face different problems during their transition stage such as retirement, they usually need a full range of A support including health care to living care[3]. client-centered case management unit to integrate all resources woul be more m re feasible feaibl to prvd moeacsil accessible and instant would provide more services. 3) Inadequate Resources of Daily Living Support Currently hand-on services are the most popular in all long term care resources. However basic daily living supports such as transportation, shopping, and barrier-free environment for the elderly are as important as other care services. Businesses or industries such as convenient stores, laundries, home delivery could be included in the service chains to provide their services. Assisted devices for activities of daily living are very useful for living support, and information technology can also provide extensive enhancement and additive value for living support and care.
B. Health Life Management Center(HLMC) y In this study, a living and health care management center was established by CTH-YHB to act as a call center and first contact window for elderly people, and to integrate a district hospital, three CMGs comprised of 17 doctors in primary care clinics. The HLMC in CTH-YHB also provided case management for all three types of service settings.
4) Ambiguity in the concept of quality control for long
education, environment control, personal service, room service and a dinning plan, etc... On the other hand, for the disabled elderly in a residential community, HiLMC in CTH-YHB could integrate and link the services of home care team and nursing home to provide case management and planning of personal healthcare, consultation, referral, and arrange admission to Elderly Residence or Nursing Home. 3) Home Care Type Service In this study, home Care type services were expected to provide the most comprehensive and high quality of living and health care either by direct or remote accesses. A mini
C. Type ofLiving and Health Care Services
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1) Residence Community Type Service Sky Tower Tuntex is a 42 stories building with more than 5000 residents. In this study, Genmart Tech promotes the Internet and living care services in this community and collaborates with HILMC in CTH-YHB to mediate integrated healthcare services for the elderly. 2) Institution (Nursing Home) Type Service Chu-Lun Senile Citizen's Apartment is a retirement residence to accommodate 180 healthy elderly Taipei citizens, and Zhi-Shan Residential and Nursing Home is a long term care institution to accommodate 550 elderly or disabled persons. Both were owned by Taipei city government and run by CTH-YHB since their establishment in 2003. In this study, the HLMC in CTH-YHB could also provide planning of health
term care
As the long term care gradually increased its quantity of services, the expectation of high quality for its management was also merging at the same time. However the stakeholders of the long term care system did not fulfill the standards of consensus, i.e. the concept of democracy. Many investments
go to retirement residence and nursing home facilities; however it does not reflect the core value of long term care including openness, participation, choice, and right,
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telematics device called babybot was designed to integrate with 7 biosensors for measuring 13 physiological parameters at maximum. This innovative home telecare information system is to enhance the long term care network. In the home setting, HLMC could also mediate the integrated services including scheduled doctor home visit, housing keeping, home healthcare nurse visit, home rehabilitant, home nutrition, etc....
III.
community medical group health information system. Currently there are about 15% primary care physicians included in CMGs and certified as family doctors. In the three CMGs linked to CTH-YHB, each has a standalone health information system server which was maintained by information service department of CTH-YHB. Many elderly people who had already registered their family doctor in one of the CMGs could be easily recruited as members of silver healthy life club.
2) CommunityInternetandothe Service
RESULTS
The residents of the community can join the membership via different service providers. The simplest way is via the Community Internet Service provider. Genmart Tech Co. provides its customers basic living and health care services at a nominal fee. The members could upgrade to higher level services such as integrating with babybot with multiple biosensors for remote physiological monitoring, health consultation, and health management just using a simple remote controller[6].
Starting from 2007, CTH-YHB established a HiLMC and linked it to three CMGs. Each CMG comprised of about 5 doctors from primary care clinics. Besides, HiLMC in CTHYHB could collaborate with National Taiwan University Hospital Bei-Hu Branch (NTUH-BHB) to provide home healthcare visit services with the backup of National Taiwan University Medical Center[5]. HiLMC in CTH-YHB could also link to Zhi-Shan Residential and Nursing Home to integrate institutional healthcare. In this way it can play a major role as the first contact window and mediate living and health care to home and community. For elderly people no mailer healthy, disabled, chronic ill or in emergency medical condition, by using the U-Care information platform lILMC can provide instant and efficient services to improve health care and quality of life.
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Celitei _*DomiclIarv HoleSlicC>3) Retirement Residence and Nursing Home *fHealthlManlageiiieiit *'*' By introducing the U-Care system to the residential institutions, the HLMC in CTH-YHB can cooperate with Fig 1. U-Care: A comprehensive living and health care Network healthcare service professionals to provide more comprehensive health promotion and management. There was no additional charge for basic function of U-Care system. The elderly residents could select value-added services paying by A. Member Recruitment of Silver Healthy Life Club themselves. In this way many living support services such as In this study a fILMC was designed to serve more than transportation, shopping, dinning, and home delivery could be 2000 elderly people (at maximum 3000) by integrating all kinds of living service providers and healthcare service easily integrated in the U-Care system. providers to establish a healthy life community network. The elderly people can join Silver Health Life Club run by HLMC B. System Architecture of U-Care Network U-Care Network has a three tier system structure. in CTH-YHB through several routes. TInstitution
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1) Appication Level There are four subcomponents of U-Care application
1) Community Medical Group(CMG) Three community medical groups, Chung Young-Ho CMG, Shuang-Ho CMG, and Healthy Shuang-Ho CMG, comprised 17 primary care doctors served the most area of Chung-Ho and Young-Ho twin cities (Shuang-Ho). Starting from 2000, family doctor system was developed with implementation of
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including terminal home device Healthy Life Babybot, Living Services, Health Care, and Case Management. The functions of Healthy Life Babybot comprise of 1.Carlendar, 2.Health plan, 3.Videoconfence, 4.Activity register, 5.User Community,
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and 6.Blog. The functions of Living Service subcomponent how to pay for these programs, because there is not only include 1.Arts service, 2.Life care service, 3.Health plan, increase of elderly people, but also decrease of children, so 4.Lifecare Plan, and 5.Scheduling. The functions of Health there will be less people who pay for the programs. To solve Care subcomponent include 1.Health examination, 2.Network the problems, in this study a U-Care system was established to clinics, 3.Home care service, 4.Helath records, 5.Helathcare provide new measures to provide and access both the living plan, and 6.Scheduling. The functions of Case Management and health care services. Additionally, the elderly people have active participation and interaction with this system. The new subcomponent include 1.Case evaluation, 2.Health plan manage, 3.Service scheduling, 4.Referral, 5.Data management, information system structure constructed could provide elderly and 6.Inquiry. people actually use and help other people to use these services. it would be effective to increase the number of workers who CAM Mdhdgdnidht Lifd Sdrvidd Hddlth Cdtd HeaIthy Lif' N valuati e will bear the cost. For that, it is necessary to encourage Aseice Babybt nc DHrat o hanm . LIfE care sermice 2geternm clinics MM f6i aesrieespecially elderly people to work and to participate in society. _-.3ideoonfece dd-lfg3mlhba 9t ln Referal 4.L bifear Plan 4.Helath recrd 0 5.Data rmangemendt 5Scheduling 5Heblathcare planbe eo - ae~ utdsilnr 4.ActR~ivyrgister .nur 6MShedulinig To dvlpa U-aesystem reuie mlidscpinr (A&u 5.UsrliCommunity In the meantime, government policy collaboration. Healthy Life Babybot Service Flow Resource Broker of Information Retrieval ManagementPlatform Management Platform endorsement, itemational exchanges, andpromotion rn _ ge nt _ Broker m g m nt jInformation Technology and Health Industries are also very o Infori,alilon IntftornmC\ioXn jimportant keys to success. In the future, we expect more ____________________________________________ international collaboration and u-Health industry could be fully HIExchange ealth lInformnation _ _ _ Fomdeveloped and promoted to the world market especially for the Plafformnxhag Gt
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AcKNOWLEDGMENT
2) IT Platform level IT platform level comprised of three subcomponent, 1. information retrieval: including health information, biosensor data, and health management data. Information gateway is required for exchange to a compatible health information standard. 2. Service flow management: requiring broker and management and log function and through an engine interface to direct the service flow.
The authors thank Ministry of Economic Affairs, Executive Yuan, Taiwan, for project funding support; Mr. Yen-Shan Lin
Resource broker management: requiring broker management function to optimize the resource allocation.
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3.
(CEO, Genmart Tech. Co.) and Ms Li-Chun Lai (Director, Angel Arts Gallery) for collaboration and information system management. REFERENCES
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DISCUSSIONS
In recent years, Taiwan has facing the aging society problem, which is one of the most challenging issues in Taiwan. The reason is that it will damage not only economy of Taiwan, but also our healthcare and quality of lives. On this problem, Taiwanese government, experts, and institutions are trying to find effective countermeasure. There are two major serious problems in aging society that have to be considered;
Korea (HEALTHCOM2005) [6] M. V. M. Figueredol, J. S. Dias2. Mobile Telemedicine System for Home Care and Patient Monitoring. Proceedings of the 26th Annual
International Conference ofthe IEEE EMBS, September 1-5, 2004
Corresponding author: Heng-Shuen Chen,
[email protected] Address: Medical College and University Hospital, National Taiwan University, No.1, Sec. 1, Ren-ai Rd, Taipei 100, Taiwa
one is the huge loading of health care and living support service, as the number of elderly people increases. The other is
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