Excellent Happy Home Ward
Khaoprangam Municipality

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Excellent Happy Home Ward, Kao PraNgamTessaban, Lopburi The situation of elderly patients who cannot or can depend only little on themselves results in increasing rate of hospital beds occupying. This entails a burden on medical bills and long-term care of patients in the hospitals.Moreover, being hospitalized for long time affects mental condition and quality of life of elderly. Even in those who are back to care for a home are left alone as all family members need to work and some are poor. The municipality realizes the problem thus initiates a project to install home care system for elderly(TOT). However, the situation of bedridden patients still occurs. In the year 2015, bedridden elderly considered by physical condition and illnesses that causes inability, little or some ability to help themselves, including disability at birth and after birth conditions is 45 from a total elderly population of 3120 people, representing 1.44 per cent.Although the number is not that much compared to the total population in the municipality, it increases from 2012 with just 33 and continue increasing every year. In 2016, the number rose to 50 and is likely to increase exponentially every year.It is forecasted that, in 2021, a number of elderly people in Kao PraNgam municipality will rise to 4,000 and a number of bedridden elderly is likely to reach 2.5 per cent (two times the current number) which means 100 bedridden elderly in the area. And although it does not seem like a lot, the problem does not affect only these bedridden elderly, but also affect family and the communities where patients live and are expected to impact on dependency issue in the future. The situation has made the municipal realized the need to study in depth on the issues of elderly in a state that cannot help themselves, the impacts on the elderly themselves, the family and the community in order to lead to solution.Studies 1) household shortages of equipment or facilities, 2) home environment with the risk of falling items 3) home environment is not hygienic 4) lack of care taker or assistant for routine work 5) lack of appropriate activities for developing emotional and mental conditions of the patients 6) care taker lacks the correct understanding to perform the care.Whenanalyse, it shows that all issues relates to the health of bedridden elderly. If the problem is considered in terms of the number of individual patients, it would seem like minority problem. However, looking in terms of health and defining wellbeing dimensions, it is the matter the municipality needs to focus and become a major issue that requires early attention as it is a matter of public health, not of any individual.

B. Strategic Approach

 2. What was the solution?
Municipality organized the participation of a multidisciplinary team with families and communities to provide services and support at home to elderly with chronicle illness and the elderly with holistically good health. Overall this is called Excellent Happy Home Ward Innovation

 3. How did the initiative solve the problem and improve people’s lives?
Excellent Happy Home Ward Innovation’s main objective isto elevate the wellbeing of patients with chronic illness and bedridden elderly who are the main target of this project to gain better health, according to the strategy of being the flagship city in health of patients and the elderly. The reason behind is that, in the past, the role of municipalities in the care of patients with chronicle illness and bedridden elderly focuses mainly on health care such as be aware of incurrent diseases and bedsore or ensure patients taking complete set of medicine. Without fully understanding the problem, it overlooked the fact that the patient has to be taken care of in other dimensions.Thus,the main strategy of this innovation is to let the patient access a comprehensive health services in all dimensions, including health, activity, society, environment and technology.Not just healthcare, there are more options than only a service by conditions. When the barriers in only looking at health dimension breaks, it creates more networks in caring for patients with chronicle disease which means the care of patient with chronicle disease and bedridden elderly at home will also be more multidisciplinary and can access and solve more problem rather than just health. In addition, there are patients with chronicle disease and elderly with both good economic status and poor participate in this project because it offers a comprehensive selection of five dimensions. That said despite solving health problem, this innovation helps to achieve equal rights and opportunities in the community unlike the typical local-focused aids or assistances which only focus on patients or elderly who are unable to help themselves or have no family taking care for. Furthermore, this innovation builds a home care system and elevates it to a prototype house. This marks the development of academic knowledge on elderly and the work of local governments that is challenging. Because it does not respond only to health, but also fulfill the role of local authorities in raising the wellbeing of the people in all target groups as well as creates the psychological value. The prototype house reflects the perfect system to care for patients at home. It makes patients and elderly feel proud and happy to be living at home and in the community that is their hometown.Even in times of illness, the community provides care system that is substantial and is contributing to the patient's way of life. This is a sentimental value that cannot be measured in money but priceless to the patients. It also creates values to family relations system. The existence of prototype house makes it possible for in-patient to stay at home with family. This relieves the anxiety of the patients' relatives in going to the hospital to care for patients. Families also feel at ease with the services of the municipality to help lighten the load resulted in better mental health of the patients' family members and contribute to better relations among relatives. It can be considered an elevation of Kao PraNgam community in health care at home.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
This innovation combines the concept of home, healthcare, spatial management and technology altogether; a whole new way of services more than just a home visit more than a conventional home care.The municipality works together with a multidisciplinary team on the design based on the idea that patients with chronicle illness and bedridden elderly as well as their families or either of them should be involved in learning process of their problem, to think, decide and reflect on their own needs within the fifth dimensions; 1) Health 2) Activity 3) Society 4) Environment 5) Technology, to which direction they want to develop their health condition into. Thus, there is no fixed pattern of services for each household; depends on home condition, background, needs. Patients with chronicle illness and bedridden elderly is, therefore, the center of decisions on the matters require multidisciplinary team support and assistance to make a happy home. The freedom to choose is what makes innovation successful.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
1) A multidisciplinary team consists of physicians, nurses, psychologists, physiotherapists, social workers who have roles in assessing and providing services in all dimensions. 2) The support team consists of private entities, team of staff from TOT company limited supports for wireless phones and private sector has a role to support equipment to the necessity and sufficiency for nursing services such as first aid bags, sphygmomanometer, blood sugar meter, household remedy, wound dressing sets, cordless phones, and so on. 3) A committee of 24 communities; senior clubs, disable clubs, volunteers, together, searches for patients with chronicle illness and bedridden elderly. The team has roles in identifying patients and gives information to join the project. 4) Kao Prangammulnicile team supports/plans projects/activities and coordinates in all sectors as well as continuously builds a network of bedridden patients caring (Home Ward). This includes setting up systems and provides services for people of all age groups that rely, long term, on others as well as provides family doctors. And, the most important aspect of this project is 5) A team of patients’ families and communities whose roles are to jointly think, decide, witness and participate in problem solving and may contribute to the building of good health in patients’ home. During 2015-2016, there are 5 households that are substantially affected by the project by successfully raise all five good health dimensions.They are 1.1 Mr. NoiPalawat, age87,a cerebral thrombosis patients 1.2 Mrs. NoiPadyon, age 78,vision impaired 1.3 Mr. Dam Dakrai, age88, Paralysis and BPH. 1.4 Sergeant Major SuthatJansuk, age59,paresis from an accident 1.5 Mr. PrayadGoytem, age69,lower body paresis Currently, all 45 households participate in the project, five of which are healthy in all five dimensions; ten complete three dimensions and thirty reach two dimensions. However, the formality of the service varies according to the condition of the house and its family and community context. The prototype house which passes the health assessment will be certified and stickered with a logo in front of the house.
 6. How was the strategy implemented and what resources were mobilized?
The main strategy used in this project is to be a flagship city of healthcare for patients with chronicle illness and bedridden elderly with the following processes. 1) January-March 2015, started to explore and study the situation before the implementation of the project as well as the impact on the families and communities of the patient prior to conception and design innovation. 2) April to June 2015, organized brainstorming and collaboration of relevant government agencies by selecting representatives from each group/club to took part in the meeting, including representatives of the elderly club, disabled club, the president of the community, representatives for the volunteers and community's representatives. So those, all sectors can jointly review and reflect on the issue. 3)October-November 2015, piloted the project by identify five households that are ready as prototype. Then, a team that composed of representatives from the municipality, elderly club, hospitals and volunteers was sent in to perform in-depth evaluation of the five dimensions and reflected on the health issues to the patients and families. Together, they decided to participate on a voluntary basis.During the end of 2015, the municipality worked with TOT Public Company Limited (PLC) to bring in technology for Excellent Happy Home Ward Innovation. When patients call Kao Prangam municipality, the officer will have patients' information, their place of stay and routing appear on screen. Emergency vehicle of the municipality will then take the patient to the hospital. 4)January-April 2016, assigned the same team participated in the assessment of the prototype house to plan a proactive workplan which includes preparing village health volunteers (VHV.) to receive training courses in taking care of patients with chronicle illness in the community, preparing action plan, home visit activity, health check, improving home surroundings to reduce the risk of falling items. 5)2016 to present, followed up and evaluated all prototype houses in every 6 months’ time to assess whether improvements or development is needed in any part of it. Resources used are; 1 Social capital consists of 1) the elderly, about 30 people; takes part in the assessment of the appropriate environment for elderly home and provides information on the history of elderly or bedridden patients.2) Local personnel: considered a cornerstone in the management and coordination of appropriate resources used in respond to the needs. The Division of Public Health is the main player. They co-operate with the Welfare Division. Education Division and Division3) People in the community of 10 villages, 24 communities, with 2 representatives per community for a total of 48 people to help in providing, coordinating and mobilizing of resources. 2. Capital in the form of institutional supports in funding and equipment consists of 1) government agencies including PraNarai hospital, Provincial Social Development and Human Security, Army Aviation Center, Artillery Battalion, Wing 2 Royal Thai Air Force and Army Aircraft Maintenance Division. 2) Local government includes Kao Prangam municipality3) Private sector consists of TOT Public Company Limited, Osotspa Company Limited 4) Public sector includes community health volunteers, elderly club, disabled club, children and youth council 5) Community consists of families of the elderly and people in the community. 3. Intellectual capital to be used in innovative home is the knowledge of appropriate environment management for bedridden patients as well as knowledge in adjusting the condition of the house. It also integrates with the resources used to create innovative prototypes home which are 1) natural resources, and 2) man-made resources, sometimes from nature, such as supporting tools patients and their families made themselves from natural materials such as wood. Moreover, there are also a modification of garden area or build coconut shell ground so that patients can practice walking and the use of natural stone in the treatment of patients at home. 4. Financial capital: budget used to support this innovation comes from three major sources; 1) main financial supports to provide or create good health in each dimension are from Kao Prangam municipality 2) secondary financial recouse comes from the patient's family. In some cases, families are financially capable of supplying or supporting the creation of home innovation to elavate health condition such as leveling the ground, home cleaning, vegetable garden etc., and 3) TOT, together with Kao Prangam municipality fund communication equipment to connect to a computer system inistalled in all participating households.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The design was born from a joint meeting to brainstorm and discuss the problems in the area among municipality council members, president of elderly club, representatives from the municipality, volunteers, representatives of elderly from senior school and academics from ThammasatUniversity. At that time, this innovation happened after an informal discussion that we have to come together to think of and create something new in order to solve the problems of increasing number of patients and disabled people and we want to see the changes taking place in all area. All parties were brainstorming. The first phase aims to make a breakthrough, House of Joy. From then on, there was a trial and error process untill Excellent Happy Home Ward Innovation happens today.

 8. What were the most successful outputs and why was the initiative effective?
1. Five prototype houses to care for bedridden patients with five health dimensions raised and guarantee from the municipality that this is a kind of home patients with chronicle illness and bedridden elderly can live happily and has been providing comprehensive service that responds to the needs. The five homes are truly prototype of healthy home. In all prototypes, there are services that cover all five health dimension, but the service may vary according to the condition of the home and the context of family and community. The prototype house passed evaluation will be certified using a sticker as a sign in front of the house. 2. Better standard of patient caring system in Kao Prangam community, a system that is tangible and can be shared with interested areas for a trial. The system was set in a clear process. There are five dimensions health indicators and evaluation framework by indicators. 3. Clear working network that works with the integration of entities in every sector including 1) organizations in both public sector consists of PraNarai hospitals, Provincial Social Development and Human Security 2) local government includes Kao Prangam municipality 3) private sector consists of TOT Public Company Limited OsotspaCo.Ltd. 4) public sector includes community health volunteers, elderly club disabled club, children and youth council 5) community consists of families of the elderly and the community working together in bringing innovation into practice. 4. Distribution of wireless phones into every home that has bedridden patients, total 45 phones in 45 households. 5. Volunteers to care for bedridden patients equipped with knowledge and certified training courses. There are 40volunteers who passed the training from PraNaraiManaraj Hospital and 6 passed the training of specialized volunteers. This innovation is effective because the objectives are well assigned to raise the health status of patients with chronicle illness and bedridden elderly to be better than a mere dimension of health, according to the strategy to make the city a flagship on health of patients and elderly. When put into practice, the innovation achieves the objective of enhancing health although not all the dimensions in every household, but the main requirement to have the access on voluntary basis helps in making the use of resources worthwide which is to integrate resources from all sectors resource allocation.

 9. What were the main obstacles encountered and how were they overcome?
The main obstacles are not being able to intervene or manage the space of patients with chronicle illness or elderly. The indicator of this innovation related to the fifth dimension. All dimensions are interrelated and connected, especially environmental dimension which is the most difficult and challenging because a worker may be required to deal with the environmental conditions of the patient, as the patient requests or as the assessment team presents the solution to the patient such as inadequate lighting, confined and non-ventilated. The condition leads to adjustment of the room to have more light and must be cleaned and the need to throw away some of the items. The aforementioned issues affect patient private space, especially when some of them got accustomed to it and would like to know what could be touch or some cases valued highly the belongings inside the house, thus changing the lives of patients to improve the environment is a great deal that depends on readiness and voluntary. In making this innovation, this problem can be overcome by a multidisciplinary team. Community committee team went in to talk to the patients and the elderly to see the advantages and disadvantages that will occur and gave them time to make a decision as well as explain to the family to get their help to convince the patient, especially the issue of adjusting home environment. This must be agreed by the family and based on understanding of the situation.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
In general, care of elderly provided by local administrations focuses on home care for the sick and bedridden elderly. Our focus, however, is primarily on health. There has been a system to provide volunteers in a form of friend visit. In most case, the assessment made to see overall problem but this innovation focuses in all aspects of care. Indicators are broadly identify based on the concept of health and no activities or services is fixed. It gives the patients and family opportunities make decision or proposal that meets their needs which is different from other basic public services that the state provides. Main benefit to patients and bedridden elderly is for them have the right and opportunity to share their comments, needs and have the right to choose services based on their interests. Rich or poor alike, everyone has the right to access the prototype house services equally. This innovation, which contributes to promoting equality and social justice, focuses on building engagement between the public sector, private sector and civil society to take part in providing service that will better suited the need of the people than the old way provided solely by the state. On the issue of the access to state services, since this innovation clearly identified target groups, using survey data, which gives all patients the access to innovation. However, because health issue requires cooperation from patients, it gives priority to mutual learning and respect the decision if the patient will voluntarily participatethe Excellent Happy Home Ward Innovation or not. If participate, what are the dimension and in what form they need development. This way, municipality can tailor the service as appropriate, not just a dozen of ready-to-wear clothes. The impact, thus, makes the innovative prototype house able to provide variety of services. Measuring by the effects of the project, it is clear that patients who participated and are accepted as a prototype house are happy and enjoy life more. All five of them have the ability to better care for themselves. Secondary benefit goes to the patient's family to feel at ease. Because local governments have a role in evaluating the patients' information and provide service according to health indicators by multidisciplinary team who works together with community and family to care for the patient, this makes the family feel relieved not to be abandoned to care of this burden alone.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
In the past, caring system for patients with chronical illness and bedridden elderly often faces the problem of inequality access,particularly patients who are poor and uneducated, since there is no assessment and setting up of clear goals. A home visit was done by rotation without monitoring systemPatients receive care primarily in health dimension. But there is no service cover solitude and the social dimension.In some cases that is unreachable or fell out the record by the municipality, the patients have to go hospitals where the procedure for access to services is difficult and time-consuming. Take an example of the patient who has to do a constant check up every three months but got sick in between. The family does not have time. So he missed the opportunity to access such medical services resulted in many negative effects. In addition, patients must take at least one day in receiving service each time, losing both time and money thus caused boredom in access to the service. Moreover, the issues found are diverse, still, the services provided cannot cover because they are provided as generalized package. Therefore, Excellent Happy Home Ward Innovation: the service that cares of patient with chronical illness and bedridden elderly at home, adjusting home environment to that of the hospital in a harmonious, appropriate fashion is like integration of government network to easier access to the people. It can reduce work process, has faster follow up visit system, from every three months to every month. The service hour is not more than two hours. The process is transparent and verifiable and develops service system that covers all dimensions. It also makes the municipality think more of the share responsibility with other agencies and starts to give importance to making all patients access to services since there is now monitoring system done by multidisciplinary team ensuring no target group left behind.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Excellent Happy Home Ward Innovation creates a caring system for the poor and vulnerable groups using community as a baseline. The mechanism works without specific restrictions. There is no social class discrimination or discourage the target group in any way. Patients with chronicle illness, both children and adults, as well as elderly, male and female have equal and complete access. The operations help enhance understanding and increase awareness of the involvement of the community, families and the patients themselves resulted in a network to support and social care for each other.

Contact Information

Institution Name:   Khaoprangam Municipality
Institution Type:   Local Government  
Contact Person:   Atchara Laongprown
Title:   Director of Technical Services and Planning Divis  
Telephone/ Fax:   +(66)89-8280484 /+(66)36-486778
Institution's / Project's Website:  
E-mail:   prowatchara@gmail.com  
Address:   Khaoprangam Municipality 103 Village No.3 Khaoprangam Sub-district Amphur Muanglopburi,Lopburi
Postal Code:   15160
City:   MuangLopburi
State/Province:   Lopburi

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