Parallel Sessions (topic areas)

TOPIC AREA 1: Offering and receiving digital support
TOPIC AREA 2: Caring for our future
TOPIC AREA 3: The pecuniary and the spiritual – who pays and who nurses?
TOPIC AREA 4: Searching for and losing meaning in life

Parallel sessions of Curaviva Switzerland are being held in german or french and simultaneously translated in german or french.

TOPIC AREA 1
Offering and receiving digital support

The digital transformation has long since also made its impact felt in the health and care sector. Recent technological innovations, the dreaded use of robots in healthcare coupled with changing expectations present carers and the cared with new challenges in equal measure. What will the 'intelligent' healthcare system develop into? And how will all stakeholders – including the regulator – respond to this?

Parallel sessions:

Prof. Andrea Belliger, Vice-Rector of Services at the Lucerne University of Teacher Education and member of the university administration:
Digital seniors – Growing old in the age of apps and clever socks

Today's digital transformation is not only changing our work and communication, but also exerting a considerable impact on values like our perceptions of illness and health. The latest technological innovations such as apps, wearables, big data in cloud storage and medical advances have given rise to an entire series of new options and services for networked, participatory patients that show one thing above all else:
we are continuing to live longer, but without feeling old.

Dr. Adrian Lobsiger, Swiss Federal Data Protection Commissioner and Nicolai Lütschg, Executive Director, Stammgemeinschaft eHealth Aargau:
eHealth and electronic patient records – from NEAT healthcare to specific applications

National Councillor Ignazio Cassis has called electronic patient records the "New Railway Link through the Alps of Healthcare". This comparison is not surprising. Not only is a technical infrastructure needed to ensure the exchange of information between healthcare professionals along the treatment chain, but also updated processes and new forms of inter-professional collaboration. This, together with the cultural change accompanying eHealth is, from the viewpoint of the Aargau eHealth healthcare services community, one of the key challenges in the digital transformation of healthcare. The heterogeneous landscape as regards the degree of digitisation in residential and nursing homes presents a further challenge. Such divergent starting positions call for a differentiated strategy to ensure connection to a certified healthcare services community. The speakers will report, from first-hand experience, how these challenges can be overcome from the perspective of a prospective healthcare services community and the experiences already gained.

Dr. Stephan Sigrist, Head of the think tank W.I.R.E.:
Hacking healthcare

The future of the healthcare system will be determined by opposing perspectives: firstly, our life expectancy is increasing which will skew the disease spectrum towards a greater number of chronically ill people and bring with it rising healthcare costs. But equally, the advances in biomedical research and the digitisation of medicine promise an ever increasing quality of healthcare. The digitisation of healthcare puts nothing less than the beginning of a new era of personalised and customised medicine on the horizon, with the promise of greater efficiency, quality and safety. Nevertheless, it is important to evaluate the potentials from different perspectives and then base our future direction on these. In order to develop tomorrow's sustainable structures, we not only need more technology, but also for patients to be taken into consideration and for nursing homes to be embedded in future structures. This approach will enable specific ideas to improve the healthcare system in small increments.

Prof. Robert Riener, Professor for Sensory-Motor Systems at the Department of Health Sciences and Technology, ETH Zürich:
When therapeutic and patient care tasks are assigned to robots

Robotic technologies are being developed or are already in standard clinical use within the different diagnostic and therapeutic phases. MR-compatible robots can support diagnostic procedures and investigations of patients with neurological disorders of the brain. Surgical interventions can be accompanied by minimally invasive telemanipulators. Robotic systems can support the hospital staff in the daily care of bedridden patients. In the field of motor rehabilitation, robots can unburden the therapists from their exhaustive and partly monotonous physical work and allow the patient performing a longer, more intensive and motivating training. Different robotic systems can be applied to control and assess the home therapy using technologies of tele-rehabilitation. Outpatients whose movement performance does not further improve can still benefit from wearable or home-based robotic devices that assist the patients in different locomotion and manipulation tasks of daily life. This interactive talk will give a visionary overview about these robotic technologies.

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TOPIC AREA 2
Caring for our future

Modern-day nursing care and the considerate shaping of the last stage of life are the core activities of every nursing home and every institution for the aged. Both medical and nursing care are in a continual state of development. This raises questions about the prescription of medication as it does about awarding the 'palliative care' quality label and new ways of dealing with dementia.

Parallel sessions:

Prof. Martial van der Linden, Professor and Vice-Dean of the Faculty of Psychology and Educational Sciences at the University of Geneva, and Prof. Jacques Gaucher, Lumière University Lyon 2, Institute of Psychology, Emeritus:
Other ways of viewing dementia and its support

1st intervention:
The predominant biomedical approach tackles dementia in terms of neurodegenerative illnesses (e.g. Alzheimer’s disease), each having a specific neurobiological cause and symptoms which distinguish them from normal ageing. This perception believes that more resources should be allocated to neurobiological research in order to identify pharmacological treatments that can be given early. We will demonstrate the myriad limits to this essentialist and categorical approach. What is needed, on the contrary, is to reintegrate the manifestations of these alleged specific illnesses into the broader spectrum of cerebral and cognitive ageing, in its more or less problematic multiple expressions, under the influence of a great number of factors (environmental, psychological, biomedical, social) that play a role throughout a person’s life. This change in perception should lead to significant shifts in the way in which evaluation, psycho-social intervention, prevention and accommodation structures are designed and developed in the long-term.

2nd intervention:
A detailed and continuous observation of elderly people diagnosed with Alzheimer’s provides information that challenges the preconceptions of the exclusively “neuropathological” picture that currently prevails. The distress associated with dependence, disorientation in terms of time, and behavioural difficulties has a wider significance than being reduced to simple manifestations of ongoing deterioration in people whose ageing is understood as strictly pathological. These people are viewed as “reduced” and treated pejoratively, resulting in misunderstandings and increased anguish in the sufferers themselves, their friends and families and the professionals who support them. Art and culture can represent contexts and opportunities able to facilitate a shift in this view and in the means of care, attention and entertainment offered to elderly Alzheimer sufferers in care homes.

Dr. Gabi Bieri, President of the Commission for Long-Term Care in the SFGG (Swiss Society for Geriatrics), Head Physician for Geriatric Services in Zurich, Medical Director of Zurich Care Centers and Helmut Bernt, Director of Nursing Services, Entlisberg Nursing Center:
Medical care in retirement and nursing homes

The structures of residential and nursing homes in Switzerland and their medical care models are far from standardised. Family doctors care for most residents. Only larger institutions have permanent medical staff who have frequently specialised in geriatrics.
The medical needs of nursing home patients are becoming increasingly complex and require more than geriatric expertise. The looming shortage of family physicians, the unregulated pay for medical work in care institutions, the increasing demands, plus the ever greater need for inter-professional collaboration can lead to a lack of or inadequate medical care in nursing home patients. Such problems will differ greatly between cantons, especially since the appointment of medical staff in care institutions in Switzerland is unregulated federally. How should the provision of patient-centred care in the future be ensured under these circumstances? What demands will be placed on such care? What are the possible care models? These issues will be presented from the perspective of a nursing professional and a nursing home physician.

Theres Meierhofer, Director of the Erlenhaus Retirement and Nursing Home, Engelberg. et. al:
Dying – an art or not?

A stay in a nursing home with the loss of bodily and mental faculties is equated to dying by those in society. No objections can really be raised here because it corresponds to reality. Structuring the last stage of life and accompaniment during death are the core functions of an elderly care institution. Every member of staff is rightly entitled to feel proud of this. Experience has shown that many very elderly people who live in a nursing home regard their own approaching death with great serenity. Dealing with life's final issues in a natural way can be comforting and soothing. This is especially true in institutions with a palliative care philosophy. Such a philosophy must have high standards for it to meet quality label requirements in palliative care. By providing an insight into their daily care activities and their send-off culture, the persons responsible from two quite different nursing homes describe how they support and encourage their residents to live their life – right to their last breath.

Dr. Christine Bourquin, pharmacist, TopPharm pharmacies and Martine Ruggli, pharmacist, Board Member of pharmaSuisse:
The pharmacist in nursing homes

Pharmacists are rarely present in care homes, and usually just to deliver medicines. However, things are changing and the importance of the pharmacist’s role in treating elderly residents is becoming more widely appreciated. In French speaking Switzerland, regional projects have been set up through which pharmacists can offer pharmaceutical care and assistance. They are responsible for the correct administration of treatments, working in conjunction with doctors and care staff based in the homes. Key to the success of these projects is ensuring a continuous supply of the required medicines, observing legal provisions and especially offering advice in the choice of therapies by proposing the most appropriate and cost-effective treatments for elderly patients. With research work carried out alongside these projects, the contribution of the pharmacists is easy to see. German speaking Switzerland is also launching personal initiatives and pilot projects in nursing homes, with concrete examples providing a measure of what is already achieved and what is possible for the future.

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TOPIC AREA 3
The pecuniary and the spiritual – who pays and who nurses?

The nursing homes of the future will be more open and client focused. They will concentrate increasingly on the quality of life of residents and staff, and take account of spiritual aspects. The demand for Spitex (home care) services will grow in parallel with this. The unrelenting needs of an increasingly older society will be costly and require many personnel. How can we fund these, and how should we allocate our financial resources?

Parallel sessions:

Dr. Werner Widmer, Director, Diakoniewerk Neumünster Foundation and Heike Pollerhoff Huber, Operations Manager, Neumünster Park Residence, Zollikerberg:
New and reimaginged former business models

What will change in the world of nursing homes in the coming years? What new demands will be placed on nursing homes in the future? What challenges will the management of nursing homes encounter? What likely strategies might help to overcome these challenges? What stumbling blocks should be avoided? The nursing home of the future will be open, a district or village centre that meets the medical/nursing, social and spiritual/existential needs of the elderly. The boundary between nursing home and Spitex (home healthcare) will become blurred in this: The nursing home of the future might also be a person's actual home.
In all strategic thinking it must not be forgotten that the day-to-day operations of nursing homes will continue to need management. Ultimately, the satisfaction of residents, family members, members of staff and an adequate EBITDA will be the decisive factors.

Beat Ringger, Executive Secretary, Think Network Switzerland and Dr. Jérôme Cosanday, Research Director, Social Policy, Avenir-Suisse:
Good care to a ripe old age – who will finance it?

1st intervention:
For several years, a think-network expert group has been getting to grips with the problems of long-term care. In an affluent society, it is unthinkable to simply allow people who are dependent on care to wallow in misery. Someone will provide their care, support and daily assistance – in the worst case, overburdened relatives or poorly paid migrant carers. At best, excellent public services will form the backbone for this and family members will contribute as much as their personal career objectives will allow. In addition to nursing homes, a wide range of care services needs to be available, i.e. 24-hour, seven-day Spitex (home healthcare), assisted housing, respite arrangements for caring relatives. This will make it possible to find the best possible solutions for each individual situation. Denmark and the canton of Vaud are adopting this approach – and with good success. Ultimately, such solutions are not more expensive, but better.

2nd intervention:
The aging of society and the increasing associated demand for care of the elderly is presenting the public sector with social and financial challenges. Avenir Suisse has analysed the organisation, costs and financing of care for the elderly in every Swiss canton:
Spitex and home services complement one another. A one-sided enlargement of either of these service providers would be counterproductive. The required approach is one of "combined community-based and residential".
Considerable savings of potentially 1.9 billion Swiss francs could be achieved if the organisation of care for the elderly throughout every canton was as efficient as the Swiss average. "Doing the right thing the right way" is called for here. In financing care services, the governmental contributions should not take costs as their yardstick, but the range of services provided. Avenir Suisse also advocates a compulsory personal care capital sum. Such a system would be an incentive for the careful use of resources and the intergenerational financing of care for the elderly.

Prof. Thomas Klie, Institute Director, AGP (Old Age, Society, Participation) Social Research at the Protestant University for Applied Sciences Freiburg:
Skilled workers as a global resource

There is already a shortage of qualified staff in the healthcare professions today. In the future this will become even more acute. What is needed to attract young people to those professions that are committed to providing professional services to people? The attractiveness of the respective profession plus excellent staff development and recruitment concepts will certainly have a bearing on this. Does this also apply to nursing staff who work beyond national borders? According to WHO criteria, active recruitment can only take place from three countries. There is a lack of healthcare professions in northern and central Europe, but also in many emerging and developing countries. Can professional qualifications be recognised? What role can refugees fulfil in the search for suitable healthcare professionals? How will their integration succeed? Should we also rely on healthcare professionals from the Far East?
These and further questions will be discussed in detail during the optional presentations.

Prof. Sabine Hahn, Head of Nursing as a Discipline, Head of Applied Nursing Research and Development, Bern University of Applied Sciences and Dr. Franziska Zuniga, postdoctoral researcher and research assistant, Nursing Science, University of Basel and Marianne Geiser, CURAVIVA Switzerland et al. and Christophe Bugnon, actor and author:
Life, quality of life and work – a contradiction?

Care and nursing institutions are under strong pressure to provide a good quality of care, in spite of the increasing care complexity and needs amongst the elderly and a shortage of professional carers. Quality within such institutions is often conceptualised using two dimensions: quality of care and quality of life. Whilst the first of these concentrates on clinical outcomes (i.e. fall-related injuries), the second dimension includes aspects like well-being, independence, social relationships and significant activeness. The results from the SHURP study (Swiss Nursing Homes Human Resources Project) and the associated RESPONS study (Residents' Perspectives of Living in Nursing Homes in Switzerland) will be presented for aspects like quality of care and quality of life. Over 5000 carers from 162 care and nursing institutions and 1000 residents from 51 such institutions were surveyed. The results attest to the high quality of Swiss care and nursing institutions but also to improvement potential in areas like aggression, pain and person-centred care.

Theatrical input:
Life and work: how do they interact?
How can nursing home staff be kept as healthy and satisfied as possible whilst also retaining them professionally in the long term? How can life-phase specific working conditions be created?
The bilingual actor, comedian and writer Christophe Bugnon addresses key questions in a dramatic way. The issues at stake include "Can work scheduling be optimised to allow for more recreational time without dramatic cost increases?" and "How can lost working days be reduced, and what makes enduring absence management successful?" and "Which practical and implementable steps support and facilitate greater work-life balance?" After this playful exploration of complex management and retention issues, the audience will be shown where practical and specific information, tools and templates can be found to help create life-phase specific working conditions for valuable employees.
Project management: Marianne Geiser, CURAVIVA Switzerland
Author(s) of partial projects: Marlies Keist, Heidi Johann, Jean-Marc Fonjallaz, Françoise Christ

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TOPIC AREA 4
Searching for and losing meaning in life

It isn't only older people who fall into a depressed state when contemplating life in old age. Even those around them, be they family members or carers, will ask themselves increasingly more frequently how their physical and mental integrity can be best retained. Self-esteem will suffer in such instances and often leads to an acute stress response. How can such situations be addressed preventively? And how can experiences of meaninglessness not only be endured but, if need be, also exploited to positive effect?

Parallel sessions:

Prof. Joachim Bauer, internist, psychiatrist and specialist in psychotherapeutic medicine at the University Medical Center Freiburg:
Why and how happiness depends on work

Our work can serve as a focus for our creativity, a source of self-esteem, a route to social connectedness and an integral part of our identity. But it also harbours dangers and can threaten our health. What must employees and their employers pay attention to in order for work to remain a driver of our well-being and our happiness?

Prof. Patrick Karcher, geriatrician, doctor at the Geriatrics Unit of the Strasbourg University Hospitals and Prof. Delphine Roulet Schwab, Haute Ecole de la Santé La Source (La Source healthcare college) in Lausanne:
Good treatment also prevents maltreatment

1st intervention:
The word “welfare” was first coined in the 1990s following almost 20 years of deliberation on early childhood care in nurseries, but was rapidly taken up and used in the context of disability and the elderly. The word was invented by professionals to redefine care and was intended to cover new working methods and approaches that took into account difficulties in the field and the rapid pace of socio-cultural change. However, the concept was gradually hijacked by the quality system and political initiatives, with good sense and imagination giving way to standardisation and measurement. This workshop endeavours to untangle the various uses of the word “welfare” and to return to the source of the concept: an opportunity to reflect on the practices employed and their improvement, and not a system for preventing ill-treatment or a tool for evaluating methodology. The caring standpoint, rather than being defined and measured, needs to be worked at, thoughtfully considered and properly exercised by those involved.

2nd intervention:
Mistreatment is a public health problem that affects many elderly people throughout the world with significant consequences for their health, quality of life and security. Although research has been ongoing in this field for a number of years, there is still no consensus as to what actually constitutes mistreatment. Moreover, this notion – still taboo – remains hazy and subject to debate among healthcare professionals responsible for the elderly. Something of a slide is also apparent, with considerations of preventing mistreatment being put to one side in favour of focusing professional and institutional discourse on the promotion of good treatment and wellbeing. So, are these two approaches really interchangeable? Can we be content with talking solely of good treatment? Are good treatment and the absence of bad treatment equivalent concepts? Based on concrete examples, this presentation will discuss the links between preventing mistreatment and promoting good treatment, questioning their respective limits and contributions.

Prof. Norbert Semmer, Emeritus Professor, Institute for Psychology, University of Bern:
Stress as a threat to self-esteem

As part of his work on the effect of stressors, the speaker has concerned himself with perceived self-worth. This interest was triggered by findings that certain forms of inadequate social support tend to cause stress, or frequently cause the person experiencing stress to refuse social support. Stress results primarily when self-esteem is threatened by certain events. It occurs especially when failure is expected. Conversely, indications of success lead to self-affirmation. Stress is also always associated with the value judgements made by others. This raises the question of why every type and manner of social support does not reduce stress.

Heinz Rüegger, Research Associate, Institut Neumünster:
Is old age in an identity crisis?

We are all continuing to age. But nobody actually wants to be old. Old age and especially very old age, however is a life stage associated with much we would prefer to avoid: losses, illnesses, frailty, dependence. This contradicts values such as strength, accomplishment, health, independence and mobility which prevail in our society. In public and media conversations, the aged are frequently seen as a burden on society. Moreover, a wide anti-aging movement has painted old age as a pathological affliction that we should all fight against. Against such a background, it is quite difficult to accept old age as a meaningful stage in life. Sociologist Peter Gross has diagnosed a real crisis of purpose concerning old age. Since only mankind seeks meaning in life, the burden of such a crisis of purpose weighs heavily. Knowing how to deal with such purpose-related matters in a helpful way poses a challenge for the affected aged as well as those around them. The presentation seeks to uncover experiences of purposefulness in old age. And also encourages any feelings of futility to be endured.

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