Conference on Healthy and Dignified Ageing

1
Who Cares? Care coordination and cooperation to
enhance quality in elderly care in the European
Union
Prof. Dr. Bernd Marin
2
Long-term care in the EU today

• Long-term care a late-comer in social protection
  systems
• Diversity and common trends in the EU
• Key policy challenges and good practices
• Better integration between health and long-term
  care
• Improved access to care for dependent old-age
  people
• Choice in publicly provided services
• Long-term care workforce policies
• Alzheimer diseases and other dementia
• Quality of services, quality assessment/control/as
  surance
• Instant JIT responsiveness, timeliness, delivery
  when needed
• Ageing in place and grace dignity, respect, TLC

3
Long-term care a late-comer

• Young subject
• Arguably the social policy area where EU Member
  Countries differ the most
• First steps as a differentiated policy field
• Common challenges interest in good practices
• Key issues for developing long-term care in the
  EU
• Enhanced coordination/integration of health and
  social care
• User-oriented approach.

4
How many receive care in institutions?
Share of older people receiving care in
institutions (most recent date)
Institutional care covers only a small percentage
of older people
6.5
Source Huber et al. (2009 forthcoming) Own
calculations based on OECD, NOSOSCO , WHO,
Eurostat and national sources.
5
Home is where youre cared for
Share of older people receiving long-term care
services at home (most recent date)
Different approaches to care
Source Huber et al. (2009 forthcoming) Own
calculations based on OECD, NOSOSCO , WHO,
Eurostat and national sources.
6
Providing more people with care
Share of older people receiving care at home and
in as institutional setting (most recent date)
Publicly provided care at home the key for wider
access to care
Source Own calculations based on OECD, NOSOSCO ,
WHO, Eurostat and national sources.
7
Differences in informal care giving
Percentage of the population aged 15 providing
informal care to a co-resident relative aged 60
(1999)
Labour of love
Intimacy at a distance
Source Huber et al. (2009, forthcoming) Own
calculations based on Walker (1999).
8
Overburdened carers
EUROBAROMETER (2007) In your opinion, do
dependent older people rely too much on their
relatives?
Lack of care services Providing care to
co-residents explaining carers burden?
Source EUROBAROMETER (2007)
9
Mid-life challenges
Providing care for older family members by
country and age group
Source OECD (2005), EUROFAMCARE national reports.
10
Reconciling work and care
On an individual level remains difficult On a
policy level can the Lisbon Strategy and support
to carers co-exist?
Employment status of main carers by country and
domain
Source National sources, EUROFAMCARE national
reports, Lamura et al. (2006).
11
How much and where are we spending?
Public expenditure on long-term care and its
distribution between home and institutional care
(most recent date)
Paradox most people cared for at home... ...
most public resources devoted to institutional
care

• Public resources
• A diverse picture
• Modest amounts dedicated to care EU15 spends
  7.6 on health and 9.1 on old-age pensions alone

Source Huber et al. (2009, forthcoming) Own
calculations based on OECD, NOSOSCO , Eurostat
and national sources.
12
Making sense of differences in expenditure
Relation between expenditure on old-age
institutional care and share of older people
benefiting from it, 2007
Different private public mixes in
expenditure Differences in quality
Source Huber et al. (2009 forthcoming) Own
calculations based on OECD, NOSOSCO, Eurostat and
national sources.
13
How deep is the beneficiaries pocket?
Users fee for institutional care, in percentage
of the APW net wage (2007)
Paying for institutional care (EU level) 51.2
of public resources devoted to 3.3 of 65... ...
yet, heavy private contributions still required.
Source Huber et al. (2009 forthcoming) Own
calculations based on national sources.
14
Trade-offs in benefit generosity
Amounts of attendance allowances in percentage of
net wage of APW and its beneficiaries (2007 or
most recent date)
Higher but targeted amounts
Generous?
Smaller portions of the pie
Source Huber et al. (2009, forthcoming).
15
The challenge of coordination and integration
Overcoming barriers



Short term Care
Residential Care
Day Care

Nursing Home Care
General Practitioner
Hospital


Other Services, Housing, etc.
Home Help
Health Care System differentiated,
professionalised, hierarchical, funded,
rights-based
Social Care System local, less professionalised,
badly funded, discretional
16
An example of good practice
Skævinge (Denmark) The Health Centre Bauneparken
24-hour integrated health and social care

• Outcomes
• No waiting time
• Room for specialized services
• Reduced hospital stays
• Below average use of resources

• How
• Person-centred
• Single point of contact
• Case management
• Self-care and prevention

17
Accessing mainstream health

• Dependent older people facing barriers in access
• Major improvements should be possible in
  rehabilitation and mental health
• Specialised research in health care for older
  people needed

Low expectations
Regulations
Age discrimination
Poverty
Gaps in geriatricians training
Mobility
18
Having a choice on care

• Pathways to increased consumer choice
• Empowering people with a budget
• Opening the care market to private providers

• Challenges
• Limits in using informal carers
• Ensuring market thickness
• Concentration of providers

What have we learned from care markets?
19
Long-term care workforce

• Long-term care workers are crucial for quality
• Care services as a job machine
• However
• Concerns remain over labour shortages
• Informal markets of care
• Can immigration fill the gap?
• Need for
• Increased skills
• Better working and paying conditions

20
Alzheimer and other dementia
Why Alzheimer and other dementia matter?

• Improved dementia assessment and care
• but tailored training of carers and improved
  early detection is still needed

Prevalence of dementia in Europe, by age-groups
(2005)
Source Alzheimer Europe (2006) based on Ferri et
al. (2005).
21
Privacy in care home

• Where dignity of care and quality of living come
  together

Percentage of people living in rooms
(institutional care), by number of beds per room
Percentage of people living in rooms
(institutional care) by number of beds per room
Source National sources and OECD (2005)
22
Future ageing in the older age groups
Current and projected share of the population
aged 80, 2006 and 2050 (selected countries)
Huber et al. (2009) based on Eurostat EUROPOP2008.
23
Ageing and public expenditure in long-term care
Ageing and public expenditure on long-term care,
2007
Source Huber et al. (2009, forthcoming) Own
calculations based on OECD, NOSOSCO , Eurostat
and national sources.
24
Trade-offs in benefit generosity
Amounts of care allowances in percentage of net
wage of APW and its beneficiaries (2007 or most
recent date)
Source Huber et al. (2009, forthcoming).