Transcript Home care in Europe An overview

Elder Care in Europe
An overview of
its history and current trends
March 23rd 2011
Социальные услуги ХХI века: пожилых людей
Санкт-Петербург
Freek Lapré (chair EAHSA)
WWW.EAHSA.EU
• The European Association of Homes and Services for
the Ageing (EAHSA) is affiliated with the International
Association of Homes and Services for the Ageing
• We have more than 2000 providers in our
membership in 15 different European countries from
all different industries related to elder care
• Based in Brussels
• Europe = Greater Europe (> EU)
5 principles of EAHSA
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Preserving dignity
Nurturing spirits in life
Comforting in partnership
Encouraging diversity
With a carefree approach
EAHSA Network
Most relevant contacts:
• IAHSA Washington DC (www.iahsa.net)
• European Commission Brussels
• European Centre for Social Welfare Policy and Research
(affiliated with UN) (www.euro.centre.org)
• AGE Platform Europe (www.age-platform.org)
• European Housing Forum (www.europeanhousingforum.org)
• European Health Management Association (www.ehma.org)
• Eden Europe (www.eden-europe.net)
• European chapters of the International Society of
Gerontechnology (www.gerontechnology.info)
Why becoming a member ?
Part of European and International Network
(EAHSA membership includes IAHSA membership):
- Self learning: bi-annual conferences
- Exchange of best practices and innovations
- Reflection on your own development
- Management exchange programmes
- Exchange of quality frameworks: IAHSA Quality
Movement, Progress indicators
Snapshot of last EAHSA conference
in Stockholm Sweden (2010)
EAHSA strategy
towards Eastern Europe
• To broaden its geographic base and membership,
EAHSA has initiated an EAHSA Eastern European
Strategy (EES), within its vision of a broader
European community
• Key components:
– Establish a “network of stakeholders” in Eastern European
countries
– Develop an EAHSA sponsored EES Forum to share information,
identify common issues, difficulties, etc.
– Identify ways in which EAHSA could work with organisations,
NGOs, , etc. to facilitate progress
– Locate sponsors for the Forum (and Strategy)
SICUAP, the Silver Time
Foundation and EAHSA
• We congratulate our colleagues in Russia and
welcome you in the EAHSA and IAHSA family
• We will build friendships between colleagues
with a common aim: improve the quality of
life of those who we serve
• We hope to learn from you and vice versa
History of elder care in Europe
• Started with family
• Churches and other charities supported this
especially when there was no family
• Communities took over
• Governments came in:
– Local
– National (moving back to local)
• Social care or health care
Supply of elder care in Europe:
an overview
• Different countries, different systems: welfare,
social care, health care
• Northern European countries: high degree of
institutionalization
• Southern and Eastern Europe: family care, but
growing demand for professional and
institutional care
• Growing importance of home care
Home care vs. institutional care
But:
USA: mostly private funded
Finance of LTC
• Mostly tax based systems
• Cost-sharing differs between countries:
– Cost sharing in institutional care
– Cost sharing in home care differs: DNK home care
is free
• Low private funding:
– Coverage by public insurance
– High rate of informal care
Focus on:
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The United Kingdom
Romania
Italy
The Netherlands
United Kingdom
• Long term care is part of social care
• Municipalities contract LTC-organisations
• Since 1990: shift from institutional care to
domiciliary care
• Non- and for-profit organizations
• PM David Cameron wants increase home care to
shorten length of stay in hospitals
• But there is a Chinese wall between social care and
NHS
Romania
• Long waiting lists for residential care
• Day care centres, but no respite care
• Home care:
– Financed by the National Health Insurance Company
– Limits until 56 days a year
• Personal assistance (paid volunteers):
– provided by municipalities for so-called grade one
handicap that is entitled by a commission
– Client or family needs to find someone who wants to
be a personal assistant
Italy
• From 70’s until ’92 no clear concept about a
comprehensive LTC, regional differences
• Still emphasis on family support, but family
support is decreasing
• Therefore strong increase of demand for
professional and institutional care
• Supply is insufficient
• 1992: National Plan for the elderly
Netherlands
• More then a century tradition of LTC starting from
charity
• In 70’s financed by government as part of health care
• Highly institutionalized and medicalized
• Large organisations
• Shift towards social care controlled by municipalities
• Complex system of financial resources
(WMO (municipality), AWBZ (public insurance),
Health Insurance (private insurance))
Future challenges LTC in Europe
• Labour: keep the sector attractive for
professionals
• New (or old ?) concepts:
de-institutionalisation, integration of informal
care
• Building appropriate housing for the elderly
• Financial sustainability
Ratio LTC staff per
recipient >65 in facilities in 2007
OECD, 2009
Financial Sustainability
of Long Term Care
% of GDP 2005
Projected % of
GDP in 2050
Increase in %
United Kingdom
1.1 %
2.1 - 3.0 %
191 – 273 %
Italy
0.6 %
2.8 - 3.5 %
467 – 583 %
Germany
1.0 %
2.2 - 2.9 %
220 – 290 %
Netherlands
1.7 %
2.9 – 3.7 %
171 – 218 %
Japan
0.9 %
2.4 – 3.1 %
267 – 344 %
USA
0.9 %
1.8 – 2.7 %
200 – 300 %
OECD, 2010
Financial pressure
Forecast debt-to-GDP and general
government financial balances, 2011
General government balance in percentage of GDP, 2011
-12
IRL
GBR
-10
USA
JPN
-8
FRA
ESP
-6
SVK
LUX
POL
CZE
DNK AUT
-4
NZL
NLD
DEU
HUN
GRC
OECD
PRT
ITA
BEL
FIN
ISL
-2
AUS
NOR
SWE
CAN
CHE
0
KOR
2
0
50
Source: OECD (2010b).
100
150
200
Gross government debt in percentage of GDP, 2011
250
Current trends in elder care:
governments
So the challenge for governments: an ageing
society and less budget.
• Moving from health care to social care
• Restoring connection between social care and
health care
• Public/private collaboration
• More individual responsibility: informal care
and cost-sharing
Current trends in elder care:
providers
The challenge: less budget and less staff
• From large scale institutions to small scale facilities
integrated in neighbourhoods
• Shift from quality of care to quality of life: more
emphasis on sustainable housing and extending
range of services at home
• Application of technology:
– As part of service supply: telehealth and telemonitoring
– To increase efficiency: electronic records of clients
Some examples
Sustainable housing
Adapted housing
32 dwellings
24 singles (18 women en 6 men) 8 couples
median age: 80 years
De Godtschalckwijk
20 dwellings
19 singles (8 men en 11 women) 1 couple
median age -70 years : 52 years
median age +70 years: 79 years
Nursing homes as habitats
Telehealth/telemonitoring
• Virtual desk
• Monitoring system
• Tele measuring of bodyfunctions
Examples are currently implemented
in the Netherlands
Virtual desk
Courtesy NjbosGroep
Monitoring systems
Courtesy NjbosGroep
Telemeasuring bodyfunctions
Innovative:
•Plug and play device
•Easily integrated in existing callcenters
of care service organizations
Courtesy VitelNet
Hope to see you all at our 2012 conference at:
27-28 september 2012
MALTA
Thank you !
With regards to:
• Dr. Francesca Colombo, OECD
• Ricardo Rodrigues, ECV
• Jean-Christophe Vanderhaegen, CBFB
• Alzheimer Europe