La regolazione dei servizi di assistenza domiciliare

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La regolazione dei servizi di assistenza
domiciliare

• LEsperienza Tedesca
• Dr. Marie-Luise Marx
• Hessisches Sozialministerium
• Bologna, 9 gennaio 2004

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Domiciliary help and care arrangements
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Domiciliary help and care
55 only get private help from their family
1,4 Mill. live at home (92)
8 professional care only
9 additional self-financed help
28 private and professional care
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The care system for the family
Self-financed services (23)
family care 92 (ca. 5 h/day)
voluntary help (11)
advisory services (16)
Services provided under care insurance 71
financial help 29 professional caregivers /
combined services
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Supporting services for domiciliary care

• mobile professional nursing services
• others, for example
• - transport and accompanying services
• - meals on wheels
• - cleaning services
• - washing services

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Quantity and providers of mobile nursing services
in Hessen
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Long Term Care Insurance under German law
(01.04.1995)

• Each health insurance company has its own care
  insurance
• claims are financed by contributions payed by the
  insured and the employer
• contribution 1,7 of gross income
• family members are also covered

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Domiciliary services provided under Care Insurance

• 1. Provision of home care nurses
• level of care I 384 / month
• level of care II 921 / month
• level of care III 1.432 / month
• special circumstances III 1.918 / month

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Domiciliary services provided under Care Insurance

• 2. Provision of financial help to the insured
• level of care I 205 / month
• level of care II 410 / month
• level of care III 665 / month

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Combined services under Care Insurance

• 1. Financial help and professional care
• 2. Day time or night time nursing-home care
• - level I 384 / month
• - level II 921 / month
• - level III 1.432 / month

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Provision of nursing-home care under Care
Insurance (01.07.1996)

• level of care I 1.023 / month
• level of care II 1.279 / month
• level of care III 1.432 / month
• special circumstances III 1.688 / month

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Domiciliary care different levels of care
required

• 56 of care recipients have
• level I
• 1 x daily care required
• minimum 90 minutes of family care daily

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Domiciliary caredifferent levels of care
required

• 33 of care recipients have
• level II
• 3 x daily care required
• minimum 3 hours of family care daily

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Domiciliary caredifferent levels of care
required

• 11 of care recipients have
• level III
• 24-hours care
• minimum 5 hours of family care daily

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Regulations under the Long Term Care Insurance

• I. Basic agreements for standards and quality
  control
• - agreed on national level between care
  insurance companies, local communities as
  providers of social care and providers (holder)
  of caring institutions

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Content

• 1. Quality of structure
• Care takes place under the responsibility of a
  professional home care nurse, which means
• 3-yearstraining as a nurse, geriatic nurse
• 2-yearswork experience
• continues professional developments of 460 hours
  to become care manager

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2. Quality of process

• description of services offered
• concept of care
• planning of care
• documentation of care
• 3. Quality of result
• monitoring effectiveness of care aims

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. Initiatives for quality control

• 5. Procedures for quality control
• federal association of care insurance
  companies instruct the Medizinischen
  Dienst der Krankenversicherung
• providers must be informed of the date
  and content of quality control

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II. Contracts regarding domiciliary care
services

• - between federal association of care insurance
  companies and local community as providers of
  social services and the providers of the
  domiciliary services

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Content

• 1. Type of care service
• 2. Costs
• 3. Free choice of care services
• 4. Organisational conditions
• advertising professional care services
• membership of professional body
• proof of appropriate insurance
• police checks

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• 5. Services must fulfil professional and economic
  standards
• 6. Documentation must be kept
• 7. Accounts must be settled monthly between the
  providers and the insurance company
• 8. Routine quality control and complaints
  procedures must be announced before-hand
• 9. Social institutions provide for catchment
  areas

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III. Care contracts

• - between local providers of care services,
  federal associations of care insurance and the
  local community as provider of social care

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Content

• 1. Accreditation of caregivers
• 2. Type, content, extent of services
• 3. Definition of local catchment area
• 4. Regulations of contract (see Nr. II.)

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Conditions for signing care contract

• 1. Care takes place under the responsibility of
  a professional home care nurse.
• 2. The care must be efficient and economic.
• 3. The care provider has to maintain an internal
  quality control.

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IV. Law of Quality Control of Care Provision
09.09.2001

• 1. The accredited care providers must take part
  in initiatives for quality control,
• 2. efficiency and quality must be proven and
• 3. type, content and extent of services must be
  agreed by contract between the provider and the
  care recipient

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Quality control of care services

• 1. Internal quality control is compulsory
• 2. External quality control through
• Medizinischer Dienst der
  Krankenkassen
• health insurance companies
• local community as additional provider of
  care