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E-CARE

Summary

Description

Operational Information

Evaluation

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Summary

The E-CARE is an innovative service which aims to integrate health and social care services for older people using ICTs.

The initiative is organised as a call centre and depending on the older person’s needs offers different services, such as telemedicine, telecare, telealarm. Each user has a dossier with data on his/her well-being, health conditions and needs. In case of need, the E-CARE system is directly linked to the Centre for Unique Booking.

It is a network which was developed by “CUP 2000”, a private company, and the following stakeholders:

  1. The Emilia-Romagna Region (funding);

  2. Local Authorities and Local Health Authorities of the Provinces of Bologna and Ferrara (the promoters);

  3. Province of Bologna, Socio-Health Territorial Conference; Province of Ferrara, Social and (role and functions of coordination).

E-CARE was set up in 2005 with a budget funds exceeding €500,000. Initially the project was launched as a trial in the Province of Bologna and then extended to Ferrara. It is now an established service in both areas, fully integrated in the local welfare systems.

There are more than 1000 users who are older than 75 years of age, have infrequent social contact with at least one frailty problem. Such care recipients have at-risk autonomy and compromised recovery after hospitalisation. Their carers (informal and formal) are indirectly targeted. The service is completely free and only a telephone and an internet connection are required. E-CARE is user-friendly, requiring little skill to use.

The project implementation is entrusted to CUP 2000, in collaboration with associations, social cooperatives and unions pensioners (CGIL, CISL, UIL). There are about 250 groups that joined the project and work closely with (27 at the central regional level and 225 at the local level), highlighting the crucial role of volunteering in the E-CARE network. E-CARE professionals are general practitioners, social workers and home nurses.

At a micro level, E-CARE improves the autonomy of older people elderly and facilitates their informal carers to reconcile care and work. At a meso level, the costs of private care organisations decrease. At a macro level, public authorities, the National Health System (NHS) and social care services save on home caring and hospitalisations, thus optimising public resources.

Description
refers to the target users, kind of service provided, ICTs typologies and devices used

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E-CARE
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Italy
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2005
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The main purpose was to create an integrated care service network for frail older people through ICT (telecare, telemonitoring, telemedicine, teleinformation, etc.) to foster, as much as possible, seniors’ permanence at home, contributing to a higher quality of life. The service aspired to facilitate seniors’ autonomy, to fight social isolation, to refine the delivery of healthcare and social services and to reduce improper hospitalisations.

 

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The initiative drivers are of different nature:

  • The main motivation was to connect the health care sector with specialised health care websites.

  • In addition, the initiative applied ICT approaches to confront the problems associated with ageing. The traditionally advanced level of this region’s welfare system helped facilitate the creation of this enterprise.

  • Another key factor was setting up the Regional Fund for Long-Term Care, which provided the necessary financial resources to create the innovative regional regulatory framework to structure innovative welfare policies for long-term, innovative care and support of frail older people and their carers. The close cooperation among public health care and social professionals and organisations has helped implement E-CARE.

  • Other drivers were to respond to the social and health needs of older people using an integrated approach, to provide safe home care, and to support older people to live at home.

  • A further motivation was the use of volunteer organisations to improve the quality of life of older people. Lastly, the service wanted to spread ICT use regionally and nationally, to renew and integrate the social and public health care systems, to favour a new approach to home care and prevention.

  • Finally, the initiative wanted to be an answer to the death of many elderly after a heat wave in summer 2003.

 

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Yes Care Recipients
Yes Informal carers
Yes Paid assistants
Yes Formal carers

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Not available

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Yes Independent Living
Yes Information and learning for carers
Yes Personal Support and Social Integration for carer
Yes Care coordination

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Support to facilitate care recipients’ to live independently, enhance their quality of life, improve the quality of care, delivery of telemedicine, telecare, telemonitoring, teleinformation and allow reservations for health care services.

The services are:

  • Social and Health Dossier containing all relevant information on each patient both from social and health perspectives.

  • Inbound Call Center from Monday to Friday, 8.00 a.m. to 6.30 p.m.; Saturday from 8.00 a.m. to 1 p.m. (toll free number)

  • Outbound weekly phone calls, according to the Individual Assistance Plan

  • Tele-monitoring of health conditions

  • Interventions by nurses and social workers in emergencies

  • Transportation, grocery delivery etc., by volunteer associations

  • Connection to accredited repairmen for small repairs at home

  • Personalised bookings via CUB-CUP

  • Contact point for general practitioners and emergency services

  • Constant and personalised contact with the Social Services

  • Financial and social security consulting at home

The monitoring system timely reports critical situations to health care services. This information gets integrated into a social-medical dossier so that relevant stakeholders can supervise care recipients.

To access the E-CARE service the seniors’ contact must be signalled:

  • By the general practitioner

  • By the social workers from the senior’s neighbourhood or municipality

  • By the home nursing service of the Local Health Authority (LHA) of Bologna

  • By volunteer associations, trade unions, churches

Moreover, senior citizens or their families, can contact the social services in their neighbourhood/municipality or call a toll free number.

 

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The project focused mainly on technological developments to improve software tools to manage the network, to monitor and to assess patients activities, promote collaborations between different ICT actors and stakeholders. In particular, software has been developed to operate the call centre, together with technology to facilitate stakeholders’ networking.

Care recipients are required only to use a simple internet connection and a telephone for contacts with CUP , contact point and professionals and for booking services. The tele-monitoring of health conditions requires the use of special devices for measuring, for example, blood pressure, glycemic and saturation levels.

E-CARE is user-friendly and does not require special skills or specific technical support, except to train formal carers of emergency services. Frail users and older people in protected hospital discharge (e.g. patients with heart failure), have a panic button, provided for free, to alert emergency services.

 

Operational Information
refers to the type of funding, budget, sustainability and organisations involved

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Public only
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Public service funding: Government, Regional, Local Authorities, non-profit public entities
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1-Public service funding: Regional, Local Authorities, non-profit public entities (Emilia-Romagna Region, Provinces, Municipalities and local Health Authorities in Bologna and Ferrara)

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Other: please specify
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Not applicable

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Trading practices:

E-CARE is totally free of charge.

With an integrated approach, trading practices are challenging to manage. E-CARE constantly invests in local, national and international e-Health and e-Care research. The company has experience developing applications using open source software.

Operational processes:

The Emilia-Romagna Region undertook several actions to improve long-term care. E-CARE has been included among the key services to finance. The idea of the project was developed after the experience of the summer heat wave in 2003, when many older people died. Local authorities decided to invest in services to help frail older people live at home and to avoid improper use of health services. In addition, the project was promoted through local welfare reforms and local volunteers were recruited, to create an integrated network of health and social services for older people and their carers.

Since 2007 the service quality improved by means of dedicated funding so as to evolve into an integral part of the regional and local welfare policies to combat frailty and develop long-term care, home care and manage the needs of older people. The initiative has developed over time into a network of citizens, associations, institutions, professionals, offering support to frail elderly.

Up until 2009 “CUP 2000” contacted and recruited frail people, and individuals at risk, from names provided by regional social and health services. From 2010 onwards, frail people have been selected by local health and social services. Self-nominations are possible too, as the initiative is known thanks to communication by word-of-mouth.

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The sustainability strategy is to recruit new users with social and/or health problems promoting health and well being behaviours, as well as their compliance to therapeutic prescriptions and their monitor to timely report critical situations to health services.

E-CARE operational and economic sustainability can benefit from investments of the Region and local stakeholders, as part of the overall health plan and the fund for the long-term care. Nevertheless, there is the risk of future under-funding from central to local governments.

To check the project sustainability E-CARE was evaluated by the University of Bologna, Department of Sociology and results showed increasing users’ number, good health records and high satisfaction among users (Cipolla et al., 2009). According to these results, there are promising chances to recruit new users and attract financial support.

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Yes Authorities
No Private Care Sector
Yes Health and Social Care Systems
Yes Third Sector
Yes Private Companies

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  1. Authorities: Emilia-Romagna Region, Provinces, Municipalities and local Health Authorities in Bologna and Ferrara

  2. Health and Social Care Systems: general practitioners, social workers and home nurses

  3. Third sector: non-profit organisations, volunteer associations, trade unions, churches

  4. Private Companies: “CUP 2000”

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Volunteering associations, trade unions and churches are the contact points to access E-CARE. They are also involved in health care facilities and hospitals (ie, Dementia Center of the Hospital “Maggiore” of Bologna, West District of the Local Health
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Yes Informal Carers
Yes Health Professionals
Yes Social Care Professionals
Yes Privately-Hired Care Assistants (inc. Migrant Care Workers)
Yes Volunteers

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General practitioners, social workers, home nurses and volunteers are the channels to access the e-Care service. Qualified professionals of the call centre try to improve the quality of life of older people and their carers by providing support, companionship and assistance in cooperation with local formal carers. Professionals create a dossier and a personalised plan for each care recipient. The dossier is a database of social and health care information, habits and living conditions, which is used to activate the E-CARE network.

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Volunteers play a pivot role. They are in charge of transportation, accompanying, grocery delivery etc., to increase the independence of older users.

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1,001 - 5,000
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Overall, users are 74% women, and the predominant group is older than 85 years of age. Over time, support interventions have been increasingly targeted to those most in need, which now involve mainly older people at higher risk of long-term care. The percentage of users with severe frailty, enrolled in the intensive E-CARE, went from 7% in 2007 to 40% in 2010.

During the first testing phase of the project (2005-2006) more than 600 older people were assisted and monitored in the Provinces of Bologna and Ferrara. As a result, the number of users of the service has grown progressively. In Bologna there were 675 clients in June 2007, 1,835 users at the end of 2008, 3,091 clients at the end of 2009 and 3,360 users at the end of December 2012. The coverage of the frail elderly residents in Bologna Local Health Authority by E-CARE is 19%. In Ferrara there were 940 users in June 2007, 1,290 clients in June 2008, 1,679 users at the end of 2008, and 2,882 clients at the end of 2012.In the territory of Ferrara, approximately 200 informal carers of family members, with mild to moderate dementia, were involved in a telemonitoring project. The characteristics this population were 2 out of 3 women, middle aged (10% older than 75 years of age), low level of education, 40% employed (25% withdrew stopped working to care). Overall, the large number of users involved in the initiative is particularly significant, and has been growing recently. In addition, it should be noted that the initiative is the largest telecare network of Europe (AUSL di Ferrara, 2009).

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Extensive communication and promotion is carried out to inform users on E-CARE services that are available. For example, two promotional E-CARE campaigns, using a brochure and a helpline, addressed to seniors were launched at the start of the hot period in summer “Heat emergency” and at the beginning of winter “Influenza Vaccine” (2013). Brochures and posters are available at the contact point and in main sites where social-health services are delivered (hospitals, GP’s and private surgeries, union pensioners offices).

Evaluation
refers to the impact of the service on end-users, care organisations and authorities

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The impact of the initiative has been evaluated internally by CUP 2000 project personnel and externally by the University of Bologna. The service has provided ongoing support to family caregivers, to reinforcing home care of elderly people with dementia; has attenuated the relational discomfort and stress has improved the gratification of family carers (Cipolla, 2009; Malvi et al., 2009). The frail old patients were helped live independently and their self confidence was increased by the use of different services supplied by initiative (Fiori, 2010)

 

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The service positively impacts on:

- Private organisations that provide care by helping to save costs and optimise resources

- Companies and the labour market by helping the informal carer to reconcile work and caring tasks, thus avoiding the added costs to substitute/replace the worker. (Cipolla, 2009; Malvi et al., 2009)

 

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An epidemiological and qualitative survey promoted by the Local Health authority of Bologna has highlighted that in two years(2005-2007) there have been 100 fewer hospital admissions, saving the health care system €600,000. 50% of citizens decreased the use of hospital services. Given that more than 70% of the users were older than 80 years of age, this is a very important result. Therefore, E-CARE is associated with a significant reduction in health care costs. In addition, a qualitative survey conducted by the same organisation showed a high level of appreciation of the service among a representative sample of social workers and health care professionals involved in the project. (Cipolla, 2009; Malvi et al., 2009)

 

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Strengths:

  1. The E-CARE network’s competitive advantage is due to its call centres and additional services working as a network and integrating health, social services and stakeholders.
  2. The E-CARE service network is one of the innovative measures of the regional welfare policy supporting the older people and their carers.
  3. E-CARE promotes a new culture of social and health services through ICT and integration.
  4. The efficacy and impact of the service, using specific tests and questionnaires, has been evaluated positively.
  5. The service is very appreciated by users and professionals. 72.1% of users perceived greater safety, 78.2% less loneliness, 70.6% have expanded their network of friends, and 2/3 perceive an improvement in health conditions (Fiori, 2010)

Weaknesses:

  1. During development of the service, it was necessary to increase the information that social and health care workers should provide to older people. Moreover, according to researchers, selection criteria of users should be more uniform. (Fiori, 2010)

Opportunities:

  1. Digital inclusion has been promoted by means of training courses, to members of associations and volunteer organisations, to teach them how to use Information Technology tools (PCs, the internet). (Fiori, 2010)

  2. By combining formal and informal care, E-CARE identified possible synergies, which could lead to savings that the public health and social systems could invest in other innovative ICT projects. (Fiori, 2010)

Threats:

  1. Reduced public financial support could endanger future financial sustainability (Fiori, 2010)

 

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The service has a regional coverage and is fully integrated in the local welfare system.
Bologna and Ferrara are offering new ICT services.

Informal carers are indirectly involved. In the future, the company plans to involve other categories of younger users (under 65 years old) with social and/or health problems. In the near future, deployment is scheduled for the entire Emilia-Romagna Region. There are also plans to gradually propose it to other Italian areas, however a proper policy, funding and an effective cooperation between local stakeholders are needed. If there are no funding problems, “CUP 2000” intends to expand the provided services, improving its appropriateness for the target group and favouring more fragile people and/or those with greater difficulties (social exclusion, economic and relational problems, health and psychological risks).

The specific nature of local company limited the transferability of the E-CARE to other countries. Nonetheless, active collaborations in several European projects and experiments are underway. The planned developments intend to promote digital inclusion and communication between citizens and the welfare system, through a shift away from a mono-service approach to a multiservice integrated network, where a variety of services are delivered to the target population by a network of providers. In this regard, an electronic dossier has been developed to allow doctors, nurses and social workers to be notified of any significant changes.

 

More Information
includes contacts, publications and accompanying documents

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References:

Azienda AUSL di Ferrara (2009) Telemonitoraggio dei bisogni delle demenze. Ferrara: AUSL Ferrara.

Cipolla C. & Guarino F. (Eds.) (2009) E-CARE e anziani fragili. Una sperimentazione tra Bologna e Ferrara. Salute e Società, special issue. Milano: Franco Angeli.

Fiori C. (2010) La rete E-CAREa supporto del paziente “fragile”. Presentation at the workshop “Telemedicina e sanità elettronica: facciamo il punto!”, Rome, 24 June 2010.

Malvi C., Pandolfi P., Lupi G., Centis E., Orsi W., Nardelli D. & Pipitone E. (2009) Il servizio e-care in provincia di Bologna. La teleassistenza per la gestione della fragilità. Presentation, Reggio Emilia (Italy), 25 September 2009.

Mrs Caterina Lena, responsible of the initiative updated this case-study in February 2014

Publications:

Lupi G. & Orsi W. (2007) Il sistema E-CARE per un welfare del cittadino. Salute e Società, 2.

Moruzzi M. (2005) Reti del nuovo Welfare. La sfida dell’E-CARE. Milano: Franco Angeli.

Pirani A. (2008) Telemedicina e Demenze: una proposta per la “Global Care” di Comunità. Paper presented at the Conference “Le tecnologie innovative a supporto dei pazienti anziani fragili”, Ferrara (Italy), 5 December 2008.

Pirani A., Romagnoni F., Marchesini L., Tulipani C. Zaccherini D., Bastelli C., De Togni A. & Anzivino F. (2007) La Qualità di Vita dei Caregiver. Paper presented at “6° Corso di Riabilitazione Cognitiva. La riabilitazione Neuropsicologica nella Malattia di Alzheimer”, Ferrara (Italy), 30 November 2007.

VV.AA. (2006). Alzheimer: la qualità di vita del caregiver. Proceedings of the Conference, Ferrara (Italy), 13 December 2006.

Resources:

www.cup2000.it

Update by Ms Caterina Lena, responsible of the service, via personal contact (February 2014).

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Contacts:

Address: CUP 2000 S.p.A., Via del Borgo di S. Pietro, 90/c – 40126 Bologna

Telephone: 0039 051 4208411

Fax: 0039 051 4208511

e-Mail: cup2000@cup2000.it

For information about the web site the web editorial staff can be contacted at: redazione.web@cup2000.it