therefore the municipality could support a community organisation in organising bingo evenings, which would facilitate social interaction. The third function is the support of informal caregivers. The municipality can provide assistance and support to informal caregivers, who support someone with health problems. Providing informal care can be experienced as a stressful burden to the caregiver. Enabling informal caregivers to provide a part of the care need prevents the use of professional care. The Wmo also contains areas of responsibility for municipalities outside of the medical sector. Homeless care, addiction prevention and care and immigrant integration courses are also mandated and funded within the scope of the Wmo. These non‐medical functions are not further discussed in this research. The national government mandates insurance companies to provide long‐term care and insurance companies contract (often non‐profit) healthcare service operators. The insurance companies expenses for long term care are fully reimbursed by the national government trough the Algemene Wet Bijzondere Ziektekosten (AWBZ). These services include home care comprising medical activities; care home with or without nursing residence and long‐term hospital admission. 1.3.3. Conclusion To summarize, five types of caregivers (secondary end users) are identified, which are supported by three different tertiary end users and appropriate laws.
Primary end user Secondary end user Tertiary end user Related Law Client/patient Self‐care Healthcare insurance org. Zvw
Informal caregiver Municipality Wmo
Community org. Municipality Wmo
Wmo‐service org. Municipality Wmo
AWBZ‐service org. National government AWBZ
to the client. For example, if transport is needed to travel to a regular social club, it is expected that a fellow club member could pick up the client. The municipality only provides this service for local journeys. For regional and national journeys, the province has a similar service. This provincial service is also defined in the Wmo.
2.4.5. Usage and costs per service
Clients Total Costs Costs Per Client
Figure 11 Social networking growth per age group From the perspective of the aims of the Wmo, usage of social network sites is very relevant. With the mass adoption of social network sites around 2006 among younger age groups, the older age groups are picking up (Pew Internet & American Life Project, 2010). 2.6.3. Economic condition of Wmo clients There is a known general connection to income or economic status and expected health condition (Sandra H. Budde, 2008) and life expectation. Given that the health condition of persons with a lower economic status is expected to deteriorate at an earlier age, the average income of Wmo clients is also expected to be lower. The municipality performed a comparison in 2005 of Wmo clients and clients of other social or income services within the municipality. The result was that 60% of Wmo clients is also part of a lower income family, by municipality standards. The average lower economic status of Wmo clients also has an impact on the digital divide, given the fact that higher income groups also have higher adoption rates of PC and internet usage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
kind, but with resources already acquired. In a similar way, the client is expected to own a vacuum cleaner for home care use. As stated in section 3.4.1, the EU’s ambition of full broadband internet access can be viewed as both an obligation for the government, but also as a call to make full use of internet services by the government and the ability to expect from its citizens to have internet access. The technical barriers of acquiring a broadband internet connection are seen as not be significant, because all major internet service providers offer an installation service at home, either for free or a reasonable price compared to the subscription price. The city wide wireless internet service, Draadloos Groningen, could also fulfil this service. When this service is fully operational, every resident in Groningen has the option of broadband internet access at home. The municipality could offer free or reduced price access to Wmo clients.
4.4. External organisations
The advantage of internet and World Wide Web (WWW) access trough a web browser on the same platform used for VVoIP is that the users can use existing websites and content available trough the web. This avoids the costs of developing new websites or content for this system alone. Vice versa, content developed for this system could also be accessed trough a regular PC and web browser, spreading the costs over more potential viewers.4.5. Conclusion
Most altered services have a matching source of funding. Only the alarm services with home adoption are un‐fundable. The table below lists the altered services, the used technology and the matching source of funding.Service Technology Funding
Infrastructure Internet connection Client
Infrastructure Videophone with a web browser General funding
Home care –
Housekeeping ‐ ‐
Home care – social Screen to screen connection General funding
Taxi services Online planning Cost saving
(efficiency)
Mobility service Electrical scoorter with navigation
onboard Cost saving (taxi services substitution)
Community
organisations Connecting trough website, IPTV Cost saving (taxi services substitution)
Home adaptation Smart home concept, alarm and
aiding devices
‐ Outdoor alarm
services Navigational aids Cost saving (taxi services substitution)
5.2. The personas
Herman Klooster, 56 Ed Veenstra, 59 Rinus Miller, 70
Family Married to Thea
Two adult children Living alone No family Widower Two daughters, one son
Social connections Works as foreman in construction. Apart from colleagues, few social connections. Few to no social contacts 10 min walk to the center One good friend Once a week visiting daughter Health
5.3. Wmo‐services per persona
The personas have been examined by a representative of the Wmo desk and have been given an informal Wmo indication for selected services.
Herman Ed Rinus Annie Mariëtte Corry Total
The costs per client for each Wmo‐service in Table 4 are aggregated averages. The costs for each service can differ per type or per client’s situation. CpC Adjusted CpC Notes Home adaptation €1.221 ‐ Full adaptation €1.831 +50% (1) ‐ Installing shelter for scooter €610 ‐50% Shared taxi €361 ‐ Shared taxi subscribers €721 +100% (2) ‐ Reimbursement private car/taxi n/a Mobility €526 ‐ Electric Wheelchair €1.053 +100% (3) ‐ Wheelchair €132 ‐75% ‐ Electrical scooter €1.053 +100% Home care €2.399 ‐ Level 1 €2.879 ‐20% (4) ‐ Level 2 €1.999 +20% Table 7 Adjusted Costs per client per service In (1) the home adaptation service is split into the two sub services. If a house does not have sufficient room to park the electrical scooter indoors, a shelter is built. This does not include any adaptation of the kitchen or bathroom. The shared taxi service has about 8.300 subscribers, but it is suspected that a large share of subscribed clients does only seldom or never use the taxi, and does not create costs. Therefore, active clients are expected to create twice the costs of the average clients (2). Leasing a motorised wheelchair or scooter is far more expensive than leasing a hand‐driven wheelchair (3). Hand‐driven wheelchairs are used more, on a 3:2 ratio. Level 2 home care is an extension of level 1 home care, at an increase of 20% of the average costs (4). Using the adjusted costs per client, the total cost of Wmo‐care per persona can be stated.
Herman Ed Rinus Annie Mariëtte Corry
