O.R. Improves Quality and Efficiency in Home Health Care

Health Care Worker takes Elderly patient's blood pressure

Elderly care systems in the Western world are facing increased costs, primarily because the elderly constitute a growing percentage of the total population. The Swedish system is publicly financed. In 2005, the cost to taxpayers at the national level was €8.8 billion ($13 billion). Stockholm’s public policy aims to make it possible for the elderly to keep living in their own homes, and for good reason: the result for the individual is increased quality of life; for the taxpayer, home health care lowers the total cost for providing the care when the alternative is paying for all the services associated with placing an elderly man or woman in a retirement home. The care is performed through visits to the elderly, and a wide range of services are performed, including cleaning, washing, medical assistance, and social support. The elderly care sector is labor intensive, and therefore good staff planning is necessary.

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The planning of home care services involves many components, such as scheduling visits, routing staff, matching visit requirements and staff competencies, fairness among staff members, and quality of services. In addition, the daily operative planning deals with many last-minute changes (for example, staff members call in sick and visits are cancelled or added) and is therefore difficult and time consuming. Traditionally, this planning has been done in early-morning staff meetings. 

Sweden Home Health Caregiver Walking Elderly Patient

The City of Stockholm has been using an operations research-based decision support system, Laps Care, in a number of units since 2003. The system is used to create the daily operative plans, in which visits to the elderly are allocated to staff members. The planning considers geographic information, calculates travel times for several transportation modes (car, bike, and walking), and makes use of optimization-based heuristic algorithms. 

With the system in place, planning time has been reduced by two thirds. This means that staff can now spend more time calling on needy clients rather than sitting through lengthy meetings. The use of resources is also more efficient. For example, there is less need to hire extra staff. This has resulted in increased efficiency of 10%–15%. Quality aspects like continuity (keeping the number of different staff members who visit each client as low as possible), maintaining a fair staff workload, and reduction of missed and rescheduled visits are considerably improved. The system has also provided managers with a better basis for economic reporting and control.

Currently, there are 200 units with 4,000 staff members in 50 Swedish municipalities that are using Laps Care, and the annual savings reported are €20–€30 million ($30–$45 million). During 2008, the City of Stockholm is rolling out another 1,000 units with 15,000 staff members, and expects to save €20–€30 million ($30–$45 million) for the city alone.