Brief description of the opportunity

There is a need for a more wide-spread diffusion and integration of technologies that are user-friendly for older people and help overcome social isolation. A number of digital platform technologies exist that allow fostering a creative support system and interaction of older people with a community connecting formal (nurses, pharmacies) and informal (unpaid) care givers (family and friends). Applications can connect older adults to caregivers and social services via an online platform in a more flexible way. Family and care givers may contribute to the provision and installation of the care service. The EU project INTEGRATE has performed several case studies that showed that compared to usual care, integrated care results in better access to health services, holistic assessment of health and social needs, a multidisciplinary care approach, better orientation to carers and patients, a clearer process and care objectives and indicators for evaluation, central coordination and improved formal and informal communication among health professionals and patients.

The objectives include:

• Improving integrated care services, including emergency care services
• Promoting health for active aging and quality of life, including healthy nutrition
• Strengthen the training of health professionals, informal (unpaid) carers in the prevention/recovery of health, including for example oral health, recovery from minor illnesses, mobility
• Improve the digital skills of carers
• Improve social connectivity - to prevent social isolation - of older people, including older people living in rural areas

Barriers and market failures

Today, several digital services for older people exist that are provided via applications and web platforms. Even though these services can provide socio-cultural and economic benefits, they are not widely used. Barriers include the following.

• Implementing these services/technologies in existing work streams. The health systems that are currently used were not designed for the use of these new services and technologies. Health systems need to be redesigned in such a way that these new services and technologies can be embedded in the system. The services need to be linked with social and long-term care to ensure care services are coordinated and informed.
• A lack of interoperability is hindering the national- and EU-scale rollout of integrated care services. Differing standards, health systems and regulatory frameworks across the EU hinder the implementation of these solutions and limit the upscaling of these solutions. This also makes it difficult to assess the impact of the individual initiatives such as the socio-economic benefits. Furthermore, the ability of EU-countries to learn from best practice solutions is hindered by the incompatibility of the different solutions, with a fragmented market as a result.
• The ICT skills of care workers and older people in the EU is limited. In 2012, 63% of citizens between 65 and 74 years old had never used the internet, and 57% of citizens had even never used a computer. In order to increase the number of older people that feel comfortable with interactive platforms, carers are needed that help with the integration of these technologies in people’s lives. However, some carers are under-skilled in this respect, forming a major barrier for the uptake of these technologies. A promising change has taken place with the introduction of the tablet, with the result that more older people are getting used to this new technology and applications.  

Market prospects – size, growth trends and scalability

It is expected that by 2060, the ratio of people in the EU that are aged 65 or above compared to the people aged 15-64 will be 50.1 percent (compared to 27.8 percent in 2015). The result is that about two people will be working for every person aged above 65 years. Correspondingly, the number of people above 65 that will need care will also increase, and it is expected that the largest increase in age-related public expenditure will come from healthcare and long-term care spending, which together will be around two percentage points of GDP (health care: +0.9pp., long-term care: +1.1pp.).

The ageing population poses a risk for the sustainability of health care financing and quality of care. The increased longevity increases the long-term demand for services and the amount of healthcare spending. A substantial proportion of healthcare costs are indirectly financed by the working population, through social security contributions, although there are wide differences across EU countries about health care systems’ financial model. The current fiscal positions of a lot of European countries – with the net deficit across all EU28 countries at 2.4% of GDP (Eurostat) makes it difficult to absorb increases in health care costs.

Integrated care could help in ensuring the sustainability of public finances, since better integration of support provided by professional caregivers and family members may increase information sharing and improve the effectiveness and efficiency of care. The introduction of ICT and telemedicine alone is expected to improve the efficiency of health care by 20 percent. Telehome technologies and tools that enable patients to receive telehealth services is predicted to grow from $6.5b in 2013 to $24b in 2019. It is expected that in 2018, 19m people worldwide will be connected to some form of professional remote monitoring, as opposed to 3m people in 2013.

Finally, evidence for improved efficiency of care services comes from Scotland, where by means of the Scottish Health Programme3, the distribution of telecare services to 44,000 people, reduced the number of emergency admissions to the hospital with 8,700 patients and admissions to older people homes with 3,800 patients. The telecare services also made it possible to speed up 2,500 hospital discharges.

Challenges - identified need for action

An aging society not only increases pressure on care providers but is also related to a lack of participation in society and increased loneliness. Loneliness negatively affects mental and physical health.

Promising opportunities are the integration of information and communication technologies (ICT) in health care products and services that alleviate the pressure on the health care system. New services make it possible to offer remote care and monitoring, which makes it easier for older people to live independently for a longer period of time. These services also change the focus from treatment to prevention.

Several services exist, for example apps and mobile services that send reminders for the intake of medicines or that support administration and decision-making.  Furthermore, a number of these services such as web platforms give patients a more central role in the management of their care. This way, the frontier of care management is brought into people’s homes. Furthermore, web platforms make it possible to integrate all kinds of services, such as monitoring, communication, content and data flows between the older people, care professionals and also family and friends. This way, not only the physical but also the mental well-being of the older people is improved. Furthermore, the change towards increasing the provision of care in a patients’ home reduces the need for (more costly) residential care.  

Installation of these IT services does come with several obstacles. First of all, people using these services need to have sufficient ICT-skills to use them. In particular, the carers that provide services on the platform need to have the necessary skills. Furthermore, organisations that provide services have to integrate this into their organisation structure and way of working, increasing interoperability.

While there are several solutions available and slowly being implemented in primary care (e.g. the installation of tools with the building of a new nursing home, integration of GPs and pharmacists), integrated care is still missing in hospitals and between specialists and general practitioners. Some stakeholders find that it has been customary to operate independently in hospitals, something that is difficult to change.

Added value of EU action

The EC can play an important role in making these service available to a wider audience and in engaging more stakeholders. Currently there are still several barriers at the European level, that could be overcome.

First, web platforms provide the opportunity to integrate all kinds of services in one place, where a customer can both enjoy communication with close relatives and get in contact with care providers about medicines and disease management. In order to make this possible, interoperability of the different European healthcare systems is necessary. The current lack of interoperability hinders the uptake of these services and reaching economies of scale. Technology providers for example do not have the possibility to market their products in other Member States, but also within Member States a fragmented market exist where platforms do not reach sufficient mass for scale.

Second, a lack of skills and experience of care professionals with these services hinders its use. More guidance and exemplary models as well as increased targeting would benefit the sector and might encourage more efficient and effective and integrated use. The IT systems/platforms have to be designed so that it is user-friendly for the older adult minimising the barrier to engage with the new technology. Furthermore, use of these services is hindered by doubts about data protection, which might be resolved by clear guidance and possibly by regulation.

There are some barriers to up-scaling. The insufficient amount of critical mass of uptake could be mitigated at a European level, where it is possible to find a larger amount of interested parties that are willing to invest and increase awareness of the economic benefits of these projects. Furthermore, at EU-level stakeholders could be engaged in public-private partnerships where risks are shared. 

Existing or planned initiatives to build on

Silver Economy policy initiatives can contribute to cost savings in the healthcare system and create socio-cultural benefits. These benefits come from more automated processes, better skills of healthcare providers and improved health and welfare of the older people. In many Member States it is recognised that action is needed in order to change the healthcare system. Initial steps have been taken by various stakeholders to develop new policy plans, for example by the World Healthcare Organisation and the Scottish government. 

The strategy on People-centred and Integrated Health Services of the World Health Organisation supports the shift towards more integrated and people-centred health services. The WHO recognises that funding of management and delivery of health services has to change and the focus should shift from the disease towards self-management and people’s needs. Suggested policy options and interventions by the WHO include: building strong primary care-based systems with a family and community-based approach, allocating a greater proportion of health expenditure to primary care, a focus on community delivered care, training for informal carers and strengthened social participation in health. 

In Scotland a “Vision and Action Plan for the right pharmaceutical care through integrated partnerships and innovation” is undertaken by the national healthcare system, NHS. The plan should result in integrated care models that are safe, effective and person centred and that enable older people to live longer healthier lives at home or in a homely setting. The programme also encourages connections between pharmacists and other health and social care professionals. Actions that will be taken by the Scottish government are for example the development of a system that will enhance the pharmacists’ role, the development of a framework for appropriate use of data and risk assessment and support of self-management through the use of mobile technology.

There are also several examples of initiatives that try to deliver integrated care and enhance the connectivity of the older people, for example in the Netherlands and in Spain.  

‘HalloZorg’ – previously called ConnectedCare - is an integrated care initiative where connectedness of the older people is improved. HalloZorg is a Dutch initiative that started in 2002 and partners with universities and care providers. The platform connects Google Calendar, Facebook and Whatapp in a safe and closed environment. The aim of the platform is for older people to form a care-network with family, friends and neighbours, as well as care professionals. The platform can be used to make appointments, manage contacts, assign tasks, send messages and photo’s, keep a diary and provides a timeline with information about who is doing what (visiting, providing care) at that day. Furthermore, the platform provides the possibility to connect sensors.

In Spain, a similar initiative was started by the Barcelona city council, called VinclesBCN. VinclesBCN is a social innovation project that aims to improve the wellbeing and social relations of the older people. The incentive for the initiative is the fact that loneliness has a negative impact on mental and physical health. A pilot was started in one district in Barcelona in 2016, with the goal to extent the pilot to other neighbourhoods and municipalities in the beginning of 2017 and reach a total of 20,000 citizens. The application itself has two user groups: a personal network with family and friends and a larger community of people in the area that have similar interests. In the latter group, approaching others and joining city activities is promoted.

A third initiative example is CanaryCare, a monitoring system developed in the UK with the goal to help people live at home for a longer period of time. The system consists of several sensors that monitor temperature levels, light and movement in the home. Canary also provides the opportunity for visitors to carry a visitor-card, in order to register which callers have visited during the day. All information is send to for example a family member in the form of an easy to read chart. Whenever an unusual pattern is discovered, the system will send an alert via text or email. Positive Canary also supports care professionals with helping people coming home from the hospital and enables more informed decision-making.

Finally, integrating care within hospitals appears to be more difficult than integrating primary care. A successful initiative in the Netherlands that was able to accomplish this is ParkinsonNet. It is a national network of caregivers that are specialised in the treatment and support of Parkinson patients. About 3,000 caregivers (e.g. neurologists, speech therapists, physiotherapists, dieticians, ergo-therapists and nurses), divided over 69 regions are connected to this network.

Recommended EU policy actions

There are several ways through which the EC can provide support, both by removing several barriers through policy actions at EU level and by leveraging national policy.

First, the EC could contribute by supporting the broad application and establishment of IT solutions across Europe, for example by stimulating the upscaling of successful pilots across Member States. In particular, the EC could stimulate development of interoperable solutions between and within the different Member States. This could for example be done by harmonisation and alignment of programmes of national policies, strategies and plans. More interoperability will result in upscaling of successful practices and will make it easier to assess the impact of integrated care solutions.

Second, the EC could aid in the development of a better understanding of data protection. This can be done by the creation of good practices and use cases, and possibly through regulation. Skills and training of care professionals relates to this. The EC could stimulate IT training in the different Member States by for example identifying of the most appropriate ICT skills. Furthermore, the EC could work with decision-makers to open up care and educational structures, which will also enable scaling-up.

Third, an important part of creating integrated care is incentivising prevention over treatment. The EC could help leverage national policies on promotion of integrated people-centred health services, and for example encourage the recognition of the pharmacist as an important care service provider.

Key stakeholders

Key stakeholders of integrated care technologies are platform providers and providers of tools for the 50+, that can be connected to the platform.

Potential users of integrate care solutions are (50+) patients and care providers. Integrated care solutions can vertically connect primary, secondary and tertiary care and horizontally connect health care, community care and social care. The resulting total number of potential users is therefore large and is increasing. The fact that 2 out of 3 people in retirement age has at least two chronic conditions and that 9 percent of GDP is currently being spent on healthcare, highlights the need for alternative care models.[1]

Patients are the key beneficiaries. Integrated care and better connectedness is expected to deliver more timely and better quality care, with a personalised approach, higher autonomy for the patient and the possibility to remain at home. Health and social care systems will benefit from integrated care because of better coordination (less operation in silos), higher efficiency because of improved healthcare processes and new organisational models. Finally, care givers would enjoy more support in providing care and easier navigation through the health system.

[1] European Partnership for Active and Healthy Aging (2015) Integrated Care and Chronic Disease Management Flyer.