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Elder Care in EuropeAn overview of
its history and current trendsMarch 23rd 2011
Социальные услуги ХХI века: пожилых людейСанкт-Петербург
Freek Lapré (chair EAHSA)
WWW.EAHSA.EU• The European Association of Homes and Services for
the Ageing (EAHSA) is affiliated with the International Association of Homes and Services for the Ageing
• We have more than 2000 providers in our membership in 15 different European countries from all different industries related to elder care
• Based in Brussels• Europe = Greater Europe (> EU)
5 principles of EAHSA• Preserving dignity• Nurturing spirits in life• Comforting in partnership• Encouraging diversity • With a carefree approach
EAHSA NetworkMost relevant contacts:• IAHSA Washington DC (www.iahsa.net)• European Commission Brussels• European Centre for Social Welfare Policy and Research
(affiliated with UN) (www.euro.centre.org)• AGE Platform Europe (www.age-platform.org)• European Housing Forum (www.europeanhousingforum.org)• European Health Management Association (www.ehma.org)• Eden Europe (www.eden-europe.net)• European chapters of the International Society of
Gerontechnology (www.gerontechnology.info)
Why becoming a member ?
Part of European and International Network (EAHSA membership includes IAHSA membership):- Self learning: bi-annual conferences- Exchange of best practices and innovations- Reflection on your own development- Management exchange programmes- Exchange of quality frameworks: IAHSA Quality
Movement, Progress indicators
EAHSA strategy towards Eastern Europe
• To broaden its geographic base and membership, EAHSA has initiated an EAHSA Eastern European Strategy (EES), within its vision of a broader European community
• Key components:– Establish a “network of stakeholders” in Eastern European
countries– Develop an EAHSA sponsored EES Forum to share information,
identify common issues, difficulties, etc. – Identify ways in which EAHSA could work with organisations,
NGOs, , etc. to facilitate progress– Locate sponsors for the Forum (and Strategy)
SICUAP, the Silver Time Foundation and EAHSA
• We congratulate our colleagues in Russia and welcome you in the EAHSA and IAHSA family
• We will build friendships between colleagues with a common aim: improve the quality of life of those who we serve
• We hope to learn from you and vice versa
History of elder care in Europe
• Started with family • Churches and other charities supported this
especially when there was no family• Communities took over• Governments came in:
– Local– National (moving back to local)
• Social care or health care
Supply of elder care in Europe: an overview
• Different countries, different systems: welfare, social care, health care
• Northern European countries: high degree of institutionalization
• Southern and Eastern Europe: family care, but growing demand for professional and institutional care
• Growing importance of home care
Finance of LTC
• Mostly tax based systems • Cost-sharing differs between countries:
– Cost sharing in institutional care– Cost sharing in home care differs: DNK home care
is free• Low private funding:
– Coverage by public insurance– High rate of informal care
United Kingdom
• Long term care is part of social care• Municipalities contract LTC-organisations• Since 1990: shift from institutional care to domiciliary
care • Non- and for-profit organizations• PM David Cameron wants increase home care to
shorten length of stay in hospitals• But there is a Chinese wall between social care and
NHS
Romania• Long waiting lists for residential care• Day care centres, but no respite care• Home care:
– Financed by the National Health Insurance Company– Limits until 56 days a year
• Personal assistance (paid volunteers): – provided by municipalities for so-called grade one
handicap that is entitled by a commission– Client or family needs to find someone who wants to be
a personal assistant
Italy• From 70’s until ’92 no clear concept about a
comprehensive LTC, regional differences• Still emphasis on family support, but family
support is decreasing• Therefore strong increase of demand for
professional and institutional care• Supply is insufficient• 1992: National Plan for the elderly
Netherlands• More then a century tradition of LTC starting from
charity• In 70’s financed by government as part of health care• Highly institutionalized and medicalized• Large organisations• Shift towards social care controlled by municipalities• Complex system of financial resources
(WMO (municipality), AWBZ (public insurance), Health Insurance (private insurance))
Future challenges LTC in Europe
• Labour: keep the sector attractive for professionals
• New (or old ?) concepts: de-institutionalisation, integration of informal care
• Building appropriate housing for the elderly• Financial sustainability
Financial Sustainability of Long Term Care
% of GDP 2005 Projected % of GDP in 2050
Increase in %
United Kingdom 1.1 % 2.1 - 3.0 % 191 – 273 %
Italy 0.6 % 2.8 - 3.5 % 467 – 583 %
Germany 1.0 % 2.2 - 2.9 % 220 – 290 %
Netherlands 1.7 % 2.9 – 3.7 % 171 – 218 %
Japan 0.9 % 2.4 – 3.1 % 267 – 344 %
USA 0.9 % 1.8 – 2.7 % 200 – 300 %
OECD, 2010
Financial pressureForecast debt-to-GDP and general government financial balances, 2011
Source: OECD (2010b).
0 50 100 150 200 250
-12
-10
-8
-6
-4
-2
0
2
-4.18
-2.13
-7.13
-2.74
-5.01
-8.34
-5.62
-1.72
Gross government debt in percentage of GDP, 2011
Gen
eral
gov
ernm
ent b
alan
ce in
per
cent
age
of G
DP,
201
1
Current trends in elder care: governments
So the challenge for governments: an ageing society and less budget.• Moving from health care to social care• Restoring connection between social care and
health care• Public/private collaboration• More individual responsibility: informal care
and cost-sharing
Current trends in elder care: providers
The challenge: less budget and less staff• From large scale institutions to small scale facilities
integrated in neighbourhoods• Shift from quality of care to quality of life: more
emphasis on sustainable housing and extending range of services at home
• Application of technology: – As part of service supply: telehealth and telemonitoring– To increase efficiency: electronic records of clients
Adapted housing
De Godtschalckwijk20 dwellings
19 singles (8 men en 11 women) 1 couplemedian age -70 years : 52 yearsmedian age +70 years: 79 years
32 dwellings
24 singles (18 women en 6 men) 8 couplesmedian age: 80 years
Telehealth/telemonitoring
• Virtual desk• Monitoring system• Tele measuring of bodyfunctions
Examples are currently implementedin the Netherlands
Telemeasuring bodyfunctions
Courtesy VitelNet
Innovative:• Plug and play device• Easily integrated in existing
callcenters of care service organizations