Home Nursing to Regenerate the Town

ORGANIZATION: Nurse & Craft
LOCATION: Kure City, Hiroshima Prefecture, Japan

2024 HAPI Grand Prize Winner

THE PROBLEM

Osaki Shimojima is an island situated in the middle of the Seto Inland Sea with a population of just about 1,600, of whom about 70 percent are aged 65 or older. Most of the households are comprised of older people living as couples or alone. It is part of the city of Kure, situated in Hiroshima Prefecture. Like other rural communities, the declining birthrate and population outflows left the local community a shell of its former self. The limited population makes it difficult to sustain services such as taxis and supermarkets, and while the area can be reached by bus from the mainland over a bridge, it is a toll bridge, adding an extra burden.

This situation has had a particularly significant impact on the health of the older residents. Inconvenient access to mainland health services, coupled with a chronic shortage of medical and nursing care services in the area, meant that people tended to ignore symptoms and put off seeking treatment until a more serious problem emerged. With no younger caregivers at home and no nursing stations on the island, it has been very difficult to provide home care and end-of-life care.

THE INNOVATION

Nurse & Craft is a social enterprise that is applying new technologies and innovative strategies to address the common question of how to promote health and wellbeing for aging populations in remote, rural areas and to encourage regional revitalization in the process.

One of the first issues to be addressed was the lack of personnel. Osaki Shimojima had previously had a visiting nursing station setup by the local medical association, but it was not financially viable and was withdrawn from the area. Due to the aging of doctors at local clinics and personnel shortages, the area faces a chronic shortage of medical and nursing care services for its older population. In response, Nurse & Craft established a new home-visit nursing station to provide medical treatment and care at home, taking advantage of telemedicine to access medical doctors on the mainland. Technological advances such as IoT and AI have shown that doctors are not necessarily needed in remote areas. This is because in the case of older people, many of them are managing chronic diseases, and it is necessary to address their lives rather than their illnesses—in essence, to improve their quality of life and encourage healthier behaviors. By helping older people in their homes, the nurses are able to serve as facilitators and interlocutors with doctors situated on the mainland, thereby gaining the trust of residents and nearby healthcare providers. This has proven to be an important factor in being able to provide palliative care as well, allowing older people to remain in their homes as they near the end of their lives.

The nurses are allowed to pursue other work at the same time, and the company has found that this combination of parallel work, a serene and affordable place to live by the sea, and the ability of nurses to be paid for health promotion rather than just treatment of illness has allowed them to attract high-quality personnel. Indeed, while some questioned the feasibility of getting qualified nurses to staff the station given its remote location, the company had attracted dozens of job inquiries in just the first two years after it launched. This model addresses the burnout that many fulltime nurses and caregivers experience by providing greater flexibility and variety in the content of their work.

The second prong of Nurse & Craft’s work is the provision of IoT healthcare services through a subscription service called “STARTWELL.” In addition to regular home visits from the nurses, the program holds health classes once a month to improve medical literacy and digital literacy among older residents, and participants use smartwatches and urinalysis kits to monitor their activity and health. This helps improve the sustainability of community healthcare and the quality of life of the elderly. It also addresses the trend toward isolation and lack of attention to regular healthcare among residents, which was worsened by the pandemic. In addition, Nurse & Craft works with outside firms to conduct field research and demonstrations for new technologies, like augmented reality (AR) applications, that can help address the shortage of human and material resources in a place like Osaki Shimojima.

And the final prong of Nurse & Craft’s work comprises efforts to promote health tourism through their Tobishima Nurse Retreat. By utilizing local natural and human capital for tourism, they seek to attract medical and nursing care professionals from outside the region, targeting medical and welfare organizations that can send their employees for retreats on the island, where they interact with the older residents, take classes, and relax. Residents are engaged in the planning and execution of this program, including a monthly lunch that brings the community together and encourages interaction with visitors to the island. Nurse & Craft has also welcomed over 200 nursing students for home nursing training, which fosters continuous interaction between residents and the younger generation.

The project has had a substantial impact on local residents. Those who have signed up for the IoT healthcare services feel reassured that the monitoring allows them to age in place, or as one client noted, “I am happy that I can live alone here knowing that this service exists!” The lunches have created a livelier community as well, promoting social engagement. One resident shared, “It’s so much fun, it makes me want to live more.” And the company is seen as a critical partner for the Kure City Department of Health and Welfare, making it possible for local medical institutions to send patients back home to the island after illness or injury. 

The model has gained recognition elsewhere in Japan, and Nurse & Craft is now working to implement its program in the city of Niimi as well, a slightly larger city in the mountains of Okayama Prefecture where about 44 percent of the population is 65 or older. They hope to continue to share the model with those throughout Japan and Asia.

KEYS TO SUCCESS

  • Bringing nurses to remote areas allows them to bridge the technology gap that can prevent older people from using telemedicine and other health technologies. They also serve as go-betweens for residents and medical practitioners, ensuring that doctors have accurate information, that patients understand and follow the doctor’s instructions, and following up if further in-person care is needed.
  • In a super-aging society, preventive care has a tremendous social impact. It is therefore important to create an environment where nurses are compensated not just for treating chronic disease and illness but also for encouraging healthier behaviors and social engagement.
  • Using remote locations as venues for field training of nursing students and creating interesting opportunities for health tourism creates an inflow of younger people who can interact with older residents, creating social engagement that improves their mental and physical health.
  • Nursing stations in remote areas are also an important way to provide palliative care and ensure that no one dies a solitary death.

FINANCIAL STRUCTURE

Nurse & Craft’s annual budget is about ¥30 million (just under US$200,000) and the company first achieved profitability in its fourth year.  They generate income through their home-visit nursing services, which are covered through the national medical and long-term care insurance systems. They also charge for their IoT STARTWELL services and for their Tobishima Nurse Retreat.

LINKS

KEYWORDS: Caregiving, Intergenerational, Medical/health services, Preventive care, Social/community engagement

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