The Aged Care System in Denmark

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The Aged Care System in Denmark

• Dr A Andrew Fleming
• Southern Cross Care (NSW ACT) Inc
• University of Western Sydney

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Denmark Some Facts

• Population of 5.3 million
• 13 over 65 years
• Demographic ageing
• By 2025 over 65s will grow by one third
• High labour force participation rates
• 76.3 persons 16 to 66 years working
• 79.1 of women work

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Denmark Some Facts

• In 2004 population 67 700,00
• 500, 000 able to manage at home
• 175,000 receive public home help
• 23,000 live in nursing homes

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Copenhagen Some Facts

• Population of 500,000
• 12.1 over 65 years
• Home and Care Service
• 95,000 visits in 17,000 homes
• Housing for older people
• 4700 purpose-built elder homes
• 4900 nursing home places

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Social Policy in Denmark

• Welfare State
• Cradle to the grave
• Universal benefits and services
• Financed through general taxes
• Centralised pension
• Decentralised system of care services
• Challenges of demographic ageing

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Welfare State Welfare Society

• Legislate and allocate funds
• OS umbrella organisation promoting the welfare
  of older Danes
• influence policy on older persons
• educate the community, e.g. dementia
• development of personal skills and knowledge

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Welfare State Welfare Society

• Develop voluntary social work
• NB volunteerism is relatively new for adult
  Danes
• target lonely and isolated older people
• fit elderly helping frail elderly,
  e.g.visiting friends program
• Using technology such as the internet and
  Webcasts

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Local Government Responsibilities

• 14 counties
• Hospitals
• Medical care outside hospitals
• Services for disabled and abusers
• 275 municipalities
• Care for dependent older persons and day care
  facilities
• Social security schemes, e.g. old age pension,
  sickness benefits, child allowance

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Intrinsic Value of Older People

• Local senior citizens council (4 years)
• Complaints Board
• Platform for communication between older people
  and local council
• All matters relevant to older people must be
  referred, e.g. reports from quality visits to
  nursing homes

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Community Residential Care

• Well developed integration and interdependence
• Linkages provide for seamless transitions
• Single point of entry
• Less choice for older Danes but this is changing

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Community Care Services

• Copenhagen (67 53, 930)
• Home nursing and home help 16,800 clients
• 95,000 visits per week
• Elderly homes 81 per 1000
• Nursing homes 114 per 1000

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Community Care Example

• Mrs W 76 years, widow, 4 children, knee and
  back problems
• Ageing in place up to 40 hours of home help
• Choice of supplier
• Home help starts immediately
• Community nursing generally through GP

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Community Care Example

• Day Care Centre 6 month contract
• Physical training provided free
• Subsidised dental treatment, transport and food
• Nursing homes have some rehab beds
• Temporary rehab home modifications
• Nursing homes 24 hour care required
• Persons given choice of nursing home

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Health promotion

• Preventive house calls
• Danes 75 offered a house call twice a year
• Aims
• Monitor health and well-being
• Advice and support regarding resources and
  services
• Maintain function and quality of life

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Fall Prevention In Copenhagen

• Healthy city project from 1994 2003
• Health targets of
• legal right to prevention
• increase average human life
• decrease social inequalities
• improve health and quality of life
• include general health in politics of local
  authority

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Fall Prevention In Copenhagen

• Provide hip protectors free of charge
• Three pairs of Safehip protectors distributed
  after
• professional assessment
• a successful one week trial which includes
  a diary of pros and cons
• Safehip to be worn a minimum of 8 hours/day

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Fall Prevention In Copenhagen

• Outcomes
• acceptance rate is approximately 33
• 35 reduction in hospital discharges
• 19 reduction in incidence per 100,000 65
• significant reduction in health spending
• NB hip protectors a supplement NOT a replacement

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Housing for Older People

• Majority live in ordinary housing
• Only 4 5 in purpose-built or nursing home
  accommodation
• Need is the primary determinant of service
• Services delivered in
• Own home, elder home or nursing home

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Housing for Older People

• Elder home
• Independent living complex with adaptive housing
• Nursing home
• Apartments with one (50 sqm) or two rooms (65
  sqm) with a kitchenette and ensuite bathroom
• Communal areas, gymnasium, open café, day centre

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Residents in Nursing Homes

• Free nursing services
• Purchase hotel services, e.g. domestic, food
  package
• Open café and day centre where people from
  general community attend for meals and/or
  services
• Gymnasium for residents and staff

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Funding and Resources

• Frail older people equivalent of 0.95 per staff
  member per day
• Persons with dementia is 1.66
• Activity centres is 0.433
• Full-time physiotherapy staff
• 88 bed RCF has 50 hours of physiotherapy over 7
  days
• Resident participation rate of 60

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Quality Assurance

• All municipalities must issue quality standards
• Monitor at least annually
• Nursing homes can expect 3 visits, 1 of which is
  short notice
• Currently developing national standards
• Exploring models as per Canada and Australia

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Lessons for Us

• Well-established focus and resourcing of wellness
  and health promotion
• Intrinsic value of older people
• Integration of community and residential care
  ease of navigation for consumers
• Increased funding of persons with dementia
• Flexible and adaptive housing at all levels

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Lessons From Us

• Choice of providers for older Australians
• Dementia care and services
• Australian Aged Care Standards