Initiative for Accessing Community Resources for Functional Ability Preservation and Healthy Aging
Despite a growing elderly population, there is currently little articulated-demand or offerings in Israel by way of community-based services preserving functional ability in old age.
This innovation from the JDC Eshel addresses this, by integrating digital tools and an inter-organizational work process, including:
• A digital system providing personally adapted information on services in geographical area and recommendations for successful aging.
• A multi-disciplinary and multi-organizational approach among service providers, and public awareness of fostering functional preservation behavior.
Background and need
Ageing stemming from increased life expectancy is challenging most developed nations. The 2015 World Health Organization Report on Aging and Health notes that the most important consideration for older adults is expected to be their ability to function, and not necessarily the presence or absence of disease.
The currently low utilization of community services for the preservation of functional ability accelerates physical, emotional and cognitive deterioration in the functioning of older adults who could have otherwise benefited from particular services and activities that would help preserve functional abilities and promoting healthy aging.
As Israel seeks to reduce dependence and institutionalization of older adults, innovative models are required to provide health and well-being in the community, including services for the preservation of functional ability. Accessible responses to preserving and improving functional ability will enable older adults to live autonomously in their homes, thus improving quality of life, promoting successful aging, reducing need for institutionalization and saving public costs.
JDC-Eshel together with Israel’s Health Ministry are developing and operating Activenet, a program for the preservation of functional ability and healthy aging.
Activenet is a program which focuses on providing accessible information and raising awareness of functional preservation services through technology, that provides recommendations on such services in given areas in accordance with the users’ functional abilities and mobilizes agents of change within the community. Cooperation among service providers facilitates utilization of the recommendations, as does promoting awareness and concepts of rehabilitation and multi-disciplinary and holistic ability preservation. The innovation lies in integrating the use of digital tools and organizational work processes. Digital tools enable automation and personalization that benefits older adults and their relatives, professionals and services. The work process enables the effective use of services through a uniform concept and tools.
The initiative includes three elements designed to enhance demand for community services and resources to preserve functioning and a healthy lifestyle:
1. An internet-based information system (http://www.activent.org.il) that locates relevant services, including an index of geographically mapped services.
2. A tool providing personal recommendations for preserving abilities and information on relevant services base on multi-disciplinary assessment of functioning ability (www.activent.org.il/form).
3. An alliance of service providers and stakeholder organizations, which embed professional concepts, processes, and cooperation within
Goals and targets
Increasing demand for existing resources and promoting a healthy lifestyle through access to personally-adapted information and encouragement of older adults to utilize all the services, resources and eligibilities in a given geographic area.
Expected individual-level results:
• Use of Activenet system
• Changed attitude to prevention, functional preservation and healthy aging
• Behavioral changes in service consumption
• Increased demand for preservation, improvement and rehab services
• Preservation and improvement of functional ability and prevention of decline
Expected system-level results
• Development of training to embed the concept, knowledge and tools for preservation of functional ability and healthy aging
• Growth in number of organizations understanding and implementing the concept and knowledge and making use of tools (Activenet) to increase service consumption
• Provision of personally-tailored services
• Heightened awareness and changed attitudes among all demographics of preserving function ability
• Activenet integration in services
• Efficient and effective service array (reducing overload and providing service continuity)
Measurement and evaluation
The program is accompanied by ongoing assessment that helps design and embed it. Evaluation is based on qualitative assessment that includes study of materials and analysis of documents and data, interviews with partners and participants, observation, focus groups and analysis of quantitative data.
Independent functioning seniors experiencing slight to medium decline, in pre-frailty or frailty stages; family members; care and treatment professionals.
Continuity and embedding
The program can be implemented by relevant government agencies (health, welfare) as well as local authorities, which will be responsible for the system, for updating services and marketing the initiative. Initial discussions are under way, with some agencies expressing an interest.
What Makes Your Project Innovative?
The program contains several innovative elements:
1.Accessibility of information & services: The program uses geolocation & mapping technology to make public services accessible to older adults
2.Personalization: multidimensional assessment tool & a unique algorithm enable adapting users’ ability level & wishes to services & activities available in a geographic location.
3.Service planning: The initiative's database enables identification of gaps between needs & available responses, allowing optimal service planning. The data include services, geolocation & mapping, information from users, & information about the socio-demographic characteristics & health condition of the population in a given geographic location.
4.Professional approach & awareness raising: An alliance of multi-sectoral organizations that have adopted a unified professional approach & tools has been established in order to provide continuity of holistic services to maximize the functional independence of older adults
What is the current status of your innovation?
• The internet site including a services database in a major city is up & running.
• Multi-dimensional functional ability evaluation tool developed & validated.
• Website & tool tested by focus group end users & their suggestions implemented.
• Stakeholder alliance formed to embed concept & tools. Within this framework, several health & welfare organizations have utilized the site & the tool.
• Program tools are being directly marketed to older adults & caregivers by professionals & volunteers.
• Training system developed for doctors & other professionals, which includes seminars, courses & workshops to embed the concept, knowledge, & skills regarding preservation of functional ability.
• Ongoing evaluation study under way assessing service use, impact of organizational alliance on service consumption, training system & technology use.
Collaborations & Partnerships
The program was developed in collaboration with Health Ministry & Israel's Mapping Center. Partners include the municipality, hospital, academia, HMOs, NGOs, business, and older adults. The following partners helped in particular ways:
- Health Ministry: policy & approach development;
- Mapping Center: geolocation and mapping;
- HMOs seek ways to reduce the burden on health services and have an interest in preventing their clients’ deterioration. They will also be among the major system users;
- Municipality: services for older adults;
- Hospital: continuum of care.
Users, Stakeholders & Beneficiaries
- Older adults & family members: personally tailored recommendations on services, based on a functional ability profile;
- Professionals: expand their holistic & multi-system approach & serve as agents of change for use of the system;
- Service Providers: Promote customer-tailored service & organizational efficiency;
- Government agencies: The initiative enables cooperation between various ministries (health, welfare) & reduces services disruption, overlap and duplication.
Results, Outcomes & Impacts
Results can be understood for different activities of the project:
- Alliance: Organizational infrastructure developed with participation of civil society, health & welfare organizations, government ministries, older adults, & others. Basic understanding & agreement reached on goals & directions.
- Doctor training: A course for strategies to promote functional abilities of older adults with functional decline. Participants expressed high-level of satisfaction with contents & relevance
- Ability level assessment tool: Study conducted among 231, 65+, found the tool was valid & reliable & could be used both when older adults report on themselves or their caregivers.
- Activenet focus group: 70 participants aged 65+ took part in 15 focus groups, expressing high level of satisfaction & suggesting the need for an online website. Participants testified that recommendations encouraged functional preservation behaviour.
- Data for example: 42% have trouble sleeping, 40% have impaired vision, 60% are at risk of falls, 60% are interested in social activities
Challenges and Failures
Given the challenge of linking government & executive arms in the field, organisers are now promoting trust building processes;
The municipality has not assumed responsibility for the process & the initiative, but the mayor has been recruited to help address the challenge.
Computerized innovation for older adults presents a digital literacy challenge. Focus groups displayed positive attitudes, but experienced difficulty using the system. Work is under way to enhance accessibility
Difficulty marketing approach & tool: Independent older adults do not feel system is relevant, & those with functional decline have trouble using it. Methods of marketing & conveying information are being examined to increase motivation to use the tools, using volunteers, family doctors & others
Mapping of public services & information update is a challenge. Extensive efforts are being made to highlight the importance of sharing information & various mechanisms are being examined to improve data updaes
Conditions for Success
The following were found to be conditions for success for this initiative:
- Government policy: Work with policy makers to promote supplementary processes, such as incentivizing widespread use of the system.
- Ownership: Finding entity to assume ownership of the initiative and responsibility for updates, maintenance, policy, etc.
- Services’ Mapping: Majority of services in every given area must be mapped.
- Marketing and information: Public education and information is required on system use, behavioural change and importance of preserving functional ability for successful aging.
- Budgets: Funding and staff required for continued services’ mapping and updates, training of professionals to embed the concept, staff to implement program tools, marketing and information budgets.
- Alliance: Continue to maintain the partnership & maintain work methodologies & continually examine other changing needs.
The initiative includes digital tools and a professional concept that allow for replication and expansion to other target populations, such as people with disabilities. They also enable expansion of other types of services, such as leisure and learning. The evaluation survey could serve as a stand-alone tool for additional public or local government services and initiatives
1. Much work with service providers remains to be done to embed the implementational concept of preserving functional ability in older adults and reducing stigmas that prevent consumption of such services and adoption of health lifestyles. Professionals tend to focus on disability rather than health, many lack a client-centred and holistic approach to treatment, communication and knowledge dissemination. Nonetheless, a joint work process with service providers, which creates trust and enables the formulation of a joint vision and understandings, creates a system-wide basis with potential for optimal and efficient provision of services by promoting intra- and inter-organizational work processes.
2. Healthy older adults are unfamiliar with the concept of preventing deterioration and find it hard to prepare accordingly for a healthy life style that promises successful aging in the future.
3. Healthcare systems are ambivalent – wanting to provide information about services but concerned about disseminating information that could generate growing demand for them. They find it hard to see the long-term advantages of preventing decline and reducing dependence and consumption of services.
4. Organizational difficulties in embedding the system: The shift from conceptualizing an idea to implementing it requires an effort on the part of organizations to participate in the initiative in its infancy (such as during the technology development stage).
5. Information about services requires collating data from a variety of sources, including older adults themselves.
6. Maintenance and updates of data are a major challenge, especially regarding information about social services not motivated by profit considerations.
7. Digital literacy for older adults: The digital gap among older adults presents difficulties in utilizing digital tools.
8. Use of the system could enhance individuals’ willingness to assume responsibility and conduct their own lives.