Resident care plan is fragmented
CriticalHealth, social, nutrition, mobility and daily care data are stored separately.
- Consequences
- Shifts and specialists rely on an incomplete view of the situation.
Business area digitalisation analysis
Social care and long-term care institutions: digitalisation analysis
How to integrate the resident care plan, daily tasks, medications, family communication and risk monitoring
- Digital maturity
- low
- Digitalisation potential
- 87/100
- Biggest challenge
- Resident care plan is fragmented
- Biggest opportunity
- One resident care plan and chain of daily actions
The greatest value lies in fewer missed actions and clearer accountability around the clock, rather than yet another reporting system.
How social care and long-term care facilities operate
The business area includes residential care homes, long-term nursing, palliative care and specialist care facilities where quality of service depends on consistent execution of daily activities across shifts.
Care is provided around the clock
Information must remain current across changing shifts, staff and professional groups.
Many people implement the plan
Nurses, personal care workers, social workers, doctors and other specialists must work towards common goals.
Small daily changes can be significant
Changes in appetite, mobility, behaviour, pain or sleep may be an early risk signal.
Technology must work at the resident's side
Staff require a quick mobile workplace, not additional form-filling at the end of a shift.
Market and technology context
Digitalisation of long-term care is driven by staff shortages, the need for mobile workplaces, closed-loop medication administration, incident prevention and secure communication with relatives.
- Staff shortages increase the importance of clarity for every actionThe system must help quickly understand what to do now, rather than require additional administration.
- Quality is measured by continuity of careIt is important not only to record the action, but to ensure that the change is passed on to the next shift and amends the plan where necessary.
- Medication safety requires a closed loopPrescription, preparation, identification, actual administration, refusal and monitoring of effects must be linked.
- Sensors create value only as an additional signalDetection of falls, exits or unusual activity must be integrated into a clear human response workflow.
Typical long-term care chain
01
Admission and needs assessment
Health, social, functional, nutrition, medication, representation and safety data are collected.
02
Individual care plan development
Goals, daily activities, medications, risk prevention, specialist involvement and review dates are defined.
03
Shift task preparation
The current plan is converted into specific staff tasks, priorities and alerts.
04
Delivery of daily care
Performances, refusals, changes in condition, medication, nutrition, mobility and other important states are registered to the resident.
05
Incident and condition change management
A fall, pressure ulcer risk, or change in behaviour or health creates an assessment, accountability and plan review.
06
Plan review and informing relatives
The team evaluates the outcome, updates the plan and, according to agreed rules, provides information to relatives or representatives.
Digital maturity model
0
Paper plans and verbal shift handovers
Daily tasks, medications, changes in condition and incidents depend on paper logs and staff memory.
1
Separate accounting and document registers
Resident data and reports are digital, but actual work with the resident and shift handovers remain manual.
2
Digitalised individual care processes Typical current situation
Electronic tasks, medication lists or an incident register are used in some areas, but the individual plan, daily execution, shift handovers and risk management do not yet form one coherent chain.
3
Integrated resident care process
The individual plan, shift tasks, medications, actual execution, changes in condition, incidents and communication with relatives are linked in one chain.
4
Data-driven risk prevention and quality Target
The facility monitors missed actions, medication discrepancies, fall and pressure ulcer risk, staff workload and plan reviews in real time.
5
Safely proactive long-term care system
Sensors and analytics help identify changes in condition, but alert thresholds, actions and plan adjustments are managed by responsible staff.
Key finding
In long-term care, digitalisation value is created not by administrative reporting, but by reliable day-to-day care delivery at the resident's bedside.
A single individual plan must become concrete shift tasks, whilst actual performance, changes in condition, medications and incidents must feed back into the current plan.
The first version should cover one department and several highest-risk processes: shift handover, daily tasks and one medication administration scenario.