Towards preventive long-term care pathways for older people A case example from Austria / Vienna

Transcription

1 Towards preventive long-term care pathways for older people A case example from Austria / Vienna 2013 National Conference on Ageing Moscow, October 9-10 Georg Ruppe Austrian Interdisciplinary Platform on Ageing (ÖPIA)

2 I. - Long-term Care (LTC) a concept in transition - Prevention and Rehabilitation within LTC II. LTC practice in Vienna challenges and implementation

3 -Long-term Care (LTC) a concept in transition -Prevention and Rehabilitation within LTC I. Long-term Care / LTC What we tend to see:

4 -Long-term Care (LTC) a concept in transition -Prevention and Rehabilitation within LTC What we see less:

5 -Long-term Care (LTC) a concept in transition -Prevention and Rehabilitation within LTC Towards an integrated system of LTC an analytical review: Social care system Services Residential care Providers Professions Methods Legal Framework Policies The formal informal divide Identity - Policies - Structures - Functions - Processes - Resources/Funding Informal carers: family, friends, migrant carers The health-social care divide Long-term care linked-in, co-ordinated, integrated? Users Health care system Hospitals - Services Providers - Professions GPs - Methods Legal Framework Policies

6 -Long-term Care (LTC) a concept in transition -Prevention and Rehabilitation within LTC Prevention and Rehabilitation within LTCWhy this issue? -Context-related preventive and rehabilitative measures represent highly potential elements for sustainable LTC -Still under-developed regarding political as well as scientific awareness - Older people with dependency problems and disabilities were not particularly evident as target groups for health promotion and preventive measures (HealthProElderly literature report) -Little research has been undertaken and little evidence provided for the effectiveness and meaningfulness of conventional as well as innovative approaches

7 -Long-term Care (LTC) a concept in transition -Prevention and Rehabilitation within LTC Prevention & Rehabilitation within LTC Practical approaches at two layers: Community (Formal and/or informal health and care services in private settings) Intermediate (Assisted and community living arrangements, day care, respite care, ) Acute (Hospital care) Residential (Nursing homes, Old age homes with care units) Specific, conventional P&R measures (top-down) Comprehensive, context / system related P&R concepts (bottom-up) Preventive medical check-up Vaccinations Cognitive training Remobilisation Rehabilitation in Rehab.-Centres Physio/Occupational Therapy Lifestyle counselling Hip protectors Palliative treatment Fall prevention Multidisciplinary work / assessments Financial security Discharge management Coordination between sectors and services Support by / for informal carers (families) Mobile health & care services ICT Information / Counselling

8 -Long-term Care (LTC) a concept in transition -Prevention and Rehabilitation within LTC Good practice examples in the case of Austria Community (Formal and/or informal health and care services in private settings) Intermediate (Assisted and community living arrangements, day care, respite care, ) Acute (Hospital care) Residential (Nursing homes, Old age homes with care units) Specific, conventional P&R measures (top-down) Comprehensive, context / system related P&R concepts (bottom-up) Preventive medical check-up Vaccinations Cognitive training Remobilisation Rehabilitation in Rehab.-Centres Physio/Occupational Therapy Lifestyle counselling Hip protectors Palliative treatment Fall prevention Multidisciplinary work / assessments Financial security Discharge management Coordination between sectors and services Support by / for informal carers (families) Mobile health & care services ICT Information / Counselling

9 II. LTC Practice in Vienna Challenges and Implementation

10 -LTC practice in Vienna System/context related P&R along LTC pathways in Vienna a) Multidisciplinary work

11 -LTC practice in Vienna Acute care Majority of older patients with poly-morbidities on wards with restricted resources/motivation for appropriate therapy and remobilisation Geriatric Acute Care/Remobilisation (AGR) with primary/secondary admission dedicated to older patients with complex and/or chronic health problems Since 1999 plan for nationwide implementation, defined quality criteria (staffing, infrastructure, available services/professions) Established within units for Internal Medicine / Neurology Core elements: Comprehensive geriatric assessment multidisciplinary diagnosis and therapy, activating care, remobilisation and social reintegration approx. 40 AGR in 6 of 9 provinces In Vienna in 2009: 358 beds; by 2015: plan for 434 beds (1) (1) ÖBIG (2010), Österreichischer Strukturplan Gesundheit Wien: BMG.

12 -LTC practice in Vienna

13 -LTC practice in Vienna b) Support by/for informal carers (family)

14 -LTC practice in Vienna Informal care at home 80-85% of care dependent elderly receive care at home from one or more relatives. (1) (2) (1) Source: BMSK (2008) Bericht des Arbeitskreises für Pflegevorsorge Wien: Bundesministerium für Soziales und Konsumentenschutz. (2) Pochobradsky et al, 2005; Carers of recipients of federal LTC allowances only; n = 1.151

15 - LTC practice in Vienna Informal care at home Support by/for informal carers (examples) Information Project Quality assurance for care at home : around home visits/year (Federal Ministry for Social Affairs together with social insurance / SV Bauern ) Care telephone; Internet platform ( Social help lines, Patient Advocacy etc. Various kinds of Preventive home visits in all regions of Austria In-cash services Public subsidies for social health and pension insurance contributions of family carers (LTC allowance level 3 and above) Financial support for the timely limited replacement of a family carer (LTC allowance 3 and above) In-kind services Day-care centres (waiting lists in Vienna; private out-of-pocket expense) Respite care / Transitional nursing home admittance (max. 5w/year; private out-of-pocket expense) Mobile care services ( with public subsidies)

16 -LTC practice in Vienna c) Mobile health & care services

17 -LTC practice in Vienna cc) Mobile health and care services Hospize & Palliative Care

18 National plan for hospice- and palliative care in Austria Preventive and cost-efficient! Average costs in last month of life: MPT: ca Hospital: ca (from to ) Source: HOSPIZ Österreich, ÖBIG 2004 Total savings. ca

19 -LTC practice in Vienna d) Financial security

20 LTC pathways and challenges

21 Priorities for LTC policy and practice: Integrated social and medical as well as formal and informal services are an essential prerequisite for LTC. Older people with already existing long-term care needs have to be recognized as important target group of preventive and rehabilitative measures. Good quality of coordination and transition processes at the system level has a large preventive and activating potential.

22 Vielen Dank!