Governance of long

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Governance of long
Long-term care in Europe – discussing trends and relevant issues
22-23 February 2010  Budapest, Hungary
Coordination and Integration of Health and Social Care
for Older Persons
Challenges and Solutions
Kai Leichsenring
European Centre for Social Welfare Policy and Research
Szocialpolitikai es
Munkaugyi Intezet
(SZMI)
Aims of the presentation
 to outline challenges for the coordination and
integration of long-term care
 to identify potential solutions for coordinating
and integrating care
 trends in long-term care governance
 new methods in managing long-term care services
 to present practical examples for enhancing
coordination and integration
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Towards an integrated system
of long-term care
Social care
system
Services
Residential care
Providers
Professions
Methods
Legal Framework
Policies
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Integrated
long-term care
system
Vision - Culture Strategies - Policies –
Financing - Methods
Processes - Quality
criteria - R&D Training
Users/clients/
patients/citizens
Health care
system
Hospitals
Services
Providers
Professions
MPs
Methods
Legal Framework
Policies
The challenge:
Overcoming barriers
Health Care System
differentiated, professionalised,
hierarchical, funded, rights-based
Short
term
Care
Hospital
General
Practitioner
Residential
Care
Nursing
Home
Care
Home
Help
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Day
Care
Other
Services,
Housing,
etc.
Social Care System
local, less professionalised,
badly funded, discretional
The challenge:
Financing long-term care (at home)
AT
DE
National State
60% 30%
(general taxes)
Social Insurance
1% 40%
covering LTC
Regional
government
20%
(Social Assistance)
Local government
(Social Assistance)
Consumer
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Other sources (incl.
Health System)
DK
FR
FI
IT
50% 24%
UK
30%
84%
95% 20% 64% 50%
19% 20% (5%) 10% 12%
10%
NL
20%
50%
16% 20%
50%
Governance of long-term care:
Different national approaches
 Introducing specific national legislation
 Subsidizing bottom-up reforms
 Reforming institutional care
 Boosting market mechanisms
 Supporting consumer-directed services
 Promoting ‘demand-driven’ policies?
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Practical tools and methods 1:
Towards coordination?
AT DE DK
Case and care
management
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Intermediate care
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Multiprofessional needs
assessment and joint
planning
Consumer directed
services
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Joint working
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FR
FI
IT
NL
UK
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Practical tools and methods 2:
Towards coordination?
AT DE DK
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Admission prevention
and guidance
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Integrating housing,
welfare and care
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Integration of family
carers
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Independent
counselling
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Coordinating care
conferences
Quality management
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FR
FI
IT
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UK
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Pathways to enhanced coordination
1
Nursing
Home
Care
Home
Help
other
services:
mealsonwheels,
etc.
The interface
between nursing
home care and other
social services
Greece - UK - Germany
Austria - Finland - NL
France
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
The case of Helsinki (Finland):
Integrated home care
for older persons living at home
 Type of integration
 a multi-professional team of 6-10 nurses, home helpers, a
home-care nurse and a chief home care officer (case
manager) in a district of 350 clients
 Methods
 first visit (assessment) at the home of the older person
(family members)
 care and service plan: medication, home care services to be
provided, frequency (days and tasks), rehabilitation plan
 defined carer: every client has his/her ‘own’ carer
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
 regular team meetings, documentation
 common space for formal and informal meetings
 continuous assessment of the care process
Pathways to enhanced coordination
2
Hospital
Nursing
Home
Care
Home
Help
General
Practitioner
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
The interface
between acute and
long-term care
Italy - UK - Denmark Austria - Finland - NL France
The case of Vienna (Austria)
Discharge management
 Type of integration/coordination
 To foster cooperation between hospital and home care
service providers
 To offer individual services for limiting the stay in hospital
 Methods
 Delegation of organising and coordinating the provision of
home care to a discharge manager
 Results
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
 Tailored support arrangements
 Promotion of mutual understanding between stakeholders
 Reduction of length of stay from 13.3 days to 9.3 days in the
ward of internal medicine within two years
 Professionalisation of discharge managers
The case of Dartford (United Kingdom)
Rehabilitation upon discharge
 Type of integration/coordination
 Intermediate care
 Horizontal and vertical integration to reduce pressure on
acute hospital beds and to help patients manage at home
 Methods
 Multi-disciplinary assessment, therapy
 Care manager and generic rehabilitation worker
 Results
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
 Effective rehabilitation assessment
 Increased staff and user satisfaction
 However: continuing problems of financial and contractual
differences
Pathways to enhanced coordination
3
The access problem:
one-stop-shops,
multidimensional
assessment and
guidance
France – Greece – Italy
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
The case of France:
Local Information and Gerontological
Co-ordination Centres (CLIC)
 Type of coordination:
 single point of entry to social and medical care in the
community
 Methods:
1) welcoming, informing, advising and supporting
2) assessing needs, compiling personalised care plans
3) implementing, monitoring and adapting care plans
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
 A small team (case manager, assistant, secretary) to
promote a mutually shared gerontological culture with all
stakeholders in the community
Pathways to integrated care
Short
term
Care
Hospital
General
Practitioner
Day
Care
Residential
Care
Nursing
Home
Care
Home
Help
Other
Services,
Housing,
etc.
4
The (almost) consolidated
direct service model:
24-hours community care centre
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Denmark
The case of Skævinge (Denmark):
The Health Centre ‘Bauneparken’
 Type of integration:
 24-hour integrated health and social care
 consolidated direct service model
 single, public provider
 Methods:
 person-centred integration of cure, care and social
inclusion of older citizens in the municipality
 a single point of contact for potential users of health
and social/personal care in the municipality
 case-management
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
 concepts of self-care and prevention
The case of Skævinge (Denmark):
The Health Centre ‘Bauneparken’
 Results:
 No waiting time for apartments or services
 Preventative efforts have entailed a surplus of capacity
used to establish more specialised services
(intermediate care)
 Number of days in hospitals for all citizens reduced by
30-40%
 No citizen has to wait for discharge in hospital
 The municipality’s use of and expenditure to national
health insurance is below the average
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227
Thank you for your interest!
For further information, please see:
www.euro.centre.org/procare
THE EUROPEAN COMMISSION
THE 5TH FRAMEWORK PROGRAMME
QUALITY OF LIFE AND
MANAGEMENT OF LIVING RESOURCES
Key Action :: The Ageing Population
and Disabilities
Contract No. QLK6-CT-2002-00227

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