Long-term care in Europe: challenges and trends

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Kathleen Jenkins
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1 Log-term care i Europe: challeges ad treds Kai Leichserig Europea Cetre for Social Welfare Policy ad Research, Viea (Austria) Health System Review Sloveia 2015 Policy Workshop o log-term care Ljubljaa 24 November 2015 Overview Emergig log-term care systems Defiitios, Ratioales, Cocepts Selected key-issues ad treds Practice examples The social iovatio potetial of LTC Coclusios: Social ivestmet eeded! 1

Towards itegrated log-term care systems Fuded by Europea Co-fuded by Austria Miistry of Sciece Social care system Services Residetial care Providers Professios Methods Legal Framework Policies The

2 Towards itegrated log-term care systems Fuded by Europea Co-fuded by Austria Miistry of Sciece Social care system Services Residetial care Providers Professios Methods Legal Framework Policies The formal iformal care divide The health-social care divide Log-term care liked-i, co-ordiated, itegrated? Idetity - Policies- Structures- Fuctios- Processes- Resources/Fudig Migrat Carers Users Voluteers Iformal carers: family, frieds Health care system Hospitals - Services Providers - Professios GPs - Methods Legal Framework Policies Sources: Leichserig et al., 2013; Why do we eed a itegrated log-term care system? Fuded by Europea Co-fuded by Austria Miistry of Sciece Outstadig success of health care system but difficulties to deal with cosequeces of survivig with chroic diseases ad LTC eeds Iformal care as backboe of LTC but difficulties to deal with icreasig burde, cultural backlogs ad role coflicts Ackowledgemet of LTC as a social risk but difficulties to overcome fragmetatio 2

3 No stadard defiitio of etitlemets Share of older people (65+) etitled to LTC i total populatio, based o atioal eligibility criteria, aroud ,0% 5,0% 4,0% 3,0% 2,0% Fuded by Europea Co-fuded by Austria Miistry of Sciece 1,0% 0,0% DK DE EL ES FR IT NL AT SI SK FI SE UK Source: Ow calculatios; Differet levels of expediture Public expeditures o LTC i per cet of GDP (2011) 4,00 3,50 3,00 2,50 2,00 1,50 1,00 0,50 0,00 Fuded by Europea Co-fuded by Austria Miistry of Sciece Source: Eurostat(latest available year) 3

4 Differet ways of fudig Log-term care expeditures by source of fudig 100% 80% 60% 40% 20% 0% Or Out-of-pocket cotributios Private Isurace Social isurace Geeral taxes Fuded by Europea Co-fuded by Austria Miistry of Sciece Source: OECD Health System Accouts, 2010 A weak relatio betwee supply ad potetial demad Fuded by Europea Co-fuded by Austria Miistry of Sciece Demography ad umber of beeficiaries aloe do ot fully explai differeces i public expediture Policies ad legacies of welfare regimes matter Differet pathways across Europe Iformal care remais backboe of log-term care 60-98% of overall LTC provisio The lack of formal care impedes a rise of (female) employmet Moral ecoomy of care vs. socio-ecoomic realities 4

5 Strategies eeded to shape elemets of a itegrated log-term care system Policy & Goverace Idetity of LTC Orgaisatioal Structures People Fuded by Europea Co-fuded by Austria Miistry of Sciece Meas Resources Pathways & Processes Maagemet & Leadership Source: Leichserig et al., 2013; Selected key-issues to costruct itegrated log-term care systems Fuded by Europea Co-fuded by Austria Miistry of Sciece Improve access ad eeds assessmet For better ways of plaig ad steerig: Multi-professioal teams to assess care eeds (Alto Adige, Italy) Embeddig prevetio ad rehabilitatio i LTC To prevet deterioratio of livig coditios: Home rehabilitatio ad activatio (Fredericia, Demark) To overcome taylorised home care (Buurtzorg, The Nerlads) Itegrated fudig To overcome social/health care divide: Joit budgets to steer care pathways (Norrtälje, Swede) 5

6 Itegrated eeds assessmet: A importat momet of truth Aim: To provide access to formal care system ad to assess idividual eeds i user s cotext Example: Assessmet by tadems (Alto Adige, Italy) Joit team of health ad social care workers Assessmet with beeficiaries ad family at home Stadardised eeds assessmet usig V.I.T.A. (Valutazioe Itegrata dei Tempi Assisteziali) istrumet Dialogue with users ad carers Focus o physical, metal, social care eeds, (istrumetal) activities of daily livig Iformatio ad care cousellig Beefits i cash ad i kid Source: Leichserig, 2008 Embeddig prevetio i log-term care Fuded by Europea Co-fuded by Austria Miistry of Sciece Aim: A paradigm shift i provisio of LTC to reduce expeditures by ivestig i prevetio ad rehabilitatio Example: Livig at home as log as possible (Fredericia, Demark) Idetifyig eeds as soo as possible (hospital, home care) A focus o self-care: Staff i a moitorig role (traiers) Itesive traiig i activities of daily livig at oset of care eeds i user s housig eviromet Retur o ivestmet after short time, better quality of care with less formal care services Source: 6

7 Re-ivetig home care Fuded by Europea Co-fuded by Austria Miistry of Sciece Aim: To overcome Taylorisatio of care ad to reduce overhead costs i home care orgaisatio Example: Buurtzorg (The Nerlads) Paradigm chage: Commuity urses provide holistic, user-cetred care i eighbourhood (promotio of self-care) Autoomous teams of commuity urses ad assistats Growth : from 12 to more tha 8,000 staff members Cost reductio aroud 40-50% as agaist ormal home care Small cetralised back-office for support services (ICT, coachig, admiistratio) Source: Huijbers, 2011; Leichserig et al., 2014 Itegrated fudig Aim: Joit health ad social care budgets to steer care pathways Example: TioHudra AB (Norrtälje, Swede) A outsourced public compay owed by couty (health) ad muicipality (social care) Hospital, Primary Care Cetres, Home Care Services Defied care pathways, discharge maagemet, home care services combiig ursig, home help ad rehabilitatio Itegrated care, choice ad competitio Source: Leichserig et al.,

8 Itegrated fudig ad user choice Source: Leichserig et al., 2015 More key-issues to costruct itegrated log-term care systems Fuded by Europea Co-fuded by Austria Miistry of Sciece Supportig iformal carers ad voluteers To overcome formal/iformal care divide: respite, cousellig ad proactive strategies Esurig quality across care pathways To implemet itegrated quality maagemet: From miimum stadards to cotiuous improvemet Ehacig goverace ad regulatory frameworks To promote itegrated care processes: From educatio to ew job profiles ad appropriate icetives To create fiacial icetives: Accoutable Care, budled budgets 8

9 Social iovatio ad social ivestmet A focus o local level ivolvig professioals, users ad carers Pilot projects with a busiess pla Public ad private ivestmet to drive orgaisatioal ad political chage Busiess kowledge ad ew types of parterships New types of employmet i local cotext Social aimatio, ew job profiles, matchig demad ad supply Social iovatio ad social ivestmet Creatio of ew products ad markets Time-bakig, social etworks, ICT applicatios Creatio of ew alliaces ad etworks Overcomig silo-thikig, iter-orgaisatioal iitiatives, research Searchig for syergies betwee sectors Housig, health ad log-term care Cross-atioal learig ad exchage of experieces 9

10 Coclusios Log-term care as a emergig system offers a wide rage of potetials for social iovatio: Still a fragile area due to lack of structural fudig ad professioal resources Realisig syergies betwee existig structures ad resources (e.g. housig, trasport, health systems) Social busiess plas, rar tha projectitis without follow-up ad sustaiable structures Furr iformatio Leichserig, K., Billigs, J. ad H. Nies(eds.) Log-term care i Europe. Improvig policy ad practice. Basigstoke 2013: Palgrave Macmilla Cotact: leichserig@euro.cetre.org 10

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