Elizabeth Mestheneos and Judy Triantafillou on behalf of ... · week for their dependent elderly (65+) family members in different regional sites. The family carers were interviewed

Elizabeth Mestheneos and Judy Triantafillou

on behalf of the EUROFAMCARE group

Supporting Family Carers of Older People in Europe –

the Pan-European Background

Supporting Family Carers of Older People in Europe –

Empirical Evidence, Policy Trends and Future Perspectives

Edited by

Hanneli Döhner and Christopher Kofahl

University of Hamburg


on behalf of the EUROFAMCARE group

Supporting Family Carers of Older People in Europe – the Pan-European Background

This report is part of the European Union funded project

“Services for Supporting Family Carers of Elderly People in Europe: Characteristics, Coverage and Usage” - EUROFAMCARE

EUROFAMCARE is an international research project funded within the 5th Framework Programme of the European Community, Key Action 6: The Ageing Population and Disabilities, 6.5: Health and Social Care Services to older People, Contract N° QLK6-CT-2002-02647 "EUROFAMCARE"

http://www.uke.uni-hamburg.de/eurofamcare/

All rights by the authors and the EUROFAMCARE-consortium.

EUROFAMCARE is co-ordinated by the University Medical Centre Hamburg-Eppendorf, Institute for Medical Sociology, Dr. Hanneli Döhner Martinistr. 52 20246 Hamburg Germany

[email protected]

This report reflects the authors’ view. It does not necessarily reflect the Euro-pean Commission's view and in no way anticipates its future policy in this area.

Designed and edited by Christopher Kofahl

Final Layout: Maik Philipp, Florian Lüdeke, Christopher Kofahl

Content

5

Content

Preface by the Editors: A Short Description of EUROFAMCARE..................... 9

The EUROFAMCARE Network ....................................................................... 11

Introduction by the Authors ............................................................................. 13

1 Background to the Report ........................................................................... 14

1.1 The EUROFAMCARE Study ................................................................. 14

1.2 Data Analysis......................................................................................... 15

1.3 Analytic Matrices ................................................................................... 16

1.4 What is Family Care? ............................................................................ 17

2 Key Issues................................................................................................... 19

2.1 Demographic Trends............................................................................. 19

2.2 Legal Obligations and Family Care and the Role of the State .............. 19

2.3 The Role of Family Care and Social Attitudes....................................... 21

2.4 The “Work” of Caring............................................................................. 23

2.4.1 Family Carers .................................................................................... 23

2.4.2 Characteristics of Family Carers ....................................................... 24

2.4.3 Is Family Care ‘real’ Work? ............................................................... 27

2.4.4 Reciprocity in Family Care Work ....................................................... 30

2.4.5 Professional Paid Care...................................................................... 31

2.4.6 Migrant and foreign Care Workers, legal and illegal ......................... 33

2.4.7 The Voluntary Sector......................................................................... 34

2.4.8 The Future of Care Work................................................................... 35

2.4.9 New Technologies............................................................................. 36

2.5 Public Investment in Care and Family Care of Older People................ 37

2.5.1 The Right to receive Care.................................................................. 37

2.5.2 Approaches to Carer Support............................................................ 38

2.5.3 The Rights of Family Carers and their financial Recognition ............ 39

2.5.4 Long-term financial Support .............................................................. 40

2.5.5 Formal Service Provision for older People (health, social services, residential) ......................................................................................... 41

2.5.6 Services for older People at Home.................................................... 42

EUROFAMCARE – Pan-European Background Report

6

2.5.7 Services for Family Carers ................................................................ 46

2.6 Residential and Long-Term Care .......................................................... 47

2.6.1 Sheltered Housing Units.................................................................... 51

2.6.2 Hospices and palliative Care............................................................. 51

2.6.3 Residential Respite Care................................................................... 51

2.6.4 Training and Quality Control and Family Carer Involvement............. 52

2.7 Current Policy Trends and Debates ...................................................... 52

3 Conclusions and Policy Implications ........................................................... 56

3.1 More Services for Family Carers and older People............................... 56

3.2 Financial Support................................................................................... 58

3.3 Working Carers...................................................................................... 59

3.4 NGOs, Advocacy, Information, legal Advice, Counselling..................... 60

3.5 Formal Labour Force............................................................................. 61

3.6 Needs Assessment ............................................................................... 62

3.7 Promotion of Health and Well-being for Family Carers ......................... 62

3.8 Evaluation and Monitoring..................................................................... 63

3.9 Integrated Care and Training ................................................................ 64

3.9.1 Professionals ..................................................................................... 64

3.9.2 Family Carers .................................................................................... 64

3.9.3 Volunteers ......................................................................................... 65

4 References .................................................................................................. 66

5 Annexes ...................................................................................................... 69

5.1 Annex 1 ................................................................................................. 69

5.1.1 NABARES Country List and Abbreviations ....................................... 69

5.1.2 NABARES Analytic Matrices and Abbreviations in Matrices............. 70

5.2 Annex 2 – Future Research Needs ....................................................... 71

5.3 Annex 3 – STEP for NABARES ............................................................ 73

5.4 Annex 4 – List of Social Services for Older People............................... 74

5.5 Annex 5 – Matrix Services for Family Carers for 23 Countries ............. 75

5.6 Annex 6 – Matrix of Family Carers’ Legal Position and Recognition by State ...................................................................................................... 78

Content

7

5.7 Annex 7 – Matrix Residential Care Services (Institutional care, includes residential homes, nursing homes, short and long term care hospitals)88

5.8 Annex 8 – Matrix of Home Based Services......................................... 108

5.9 Annex 9 – Matrix: Care of dependent older People – current and future Supply of formal and informal Care Givers ......................................... 125

5.10 Annex 10 – Matrix: Other Issues ......................................................... 142

Short Description of EUROFAMCARE

9

Preface by the Editors: A Short Description of EUROFAMCARE

EUROFAMCARE is the acronym of the project “Services for Supporting Family Carers of Elderly People in Europe: Characteristics, Coverage and Usage” funded by the EU within the 5th Framework Programme “Quality of Life and Management of Living Resources”. As part of the Key Action 6: The Ageing Population and Disabilities; 6.5: Health and Social Care Services to older Peo-ple, it aims to provide a European review of the situation of family carers of elderly people in relation to the existence, familiarity, availability, use and ac-ceptability of supporting services.

Six-Country Study

In 2003 six countries (Germany, Greece, Italy, Poland, Sweden, United King-dom) formed a trans-European group representing some of the different types of welfare-states in Europe and started a comparative study. Each country col-lected data from about 1,000 family carers who care for at least four hours a week for their dependent elderly (65+) family members in different regional sites. The family carers were interviewed face-to-face at home using a joint family care assessment instrument.

The views of potential service providers involved were obtained in 2004. Quantitative and qualitative data from these interviews were entered in Na-tional Data Sets and a European data base compiled for cross-national analy-sis. A typology of care settings will be developed considering examples of good practice and beneficial and obstructive circumstances.

Pan-European Review

Pan-European expertise, knowledge and background information about the support, relief and expertise of family carers, recognising the variety of the dif-ferent social, health and welfare systems in an expanding Europe, have been achieved by reviews and expert interviews in the six project countries plus 17 further European countries.

AGE – the European Older People's Platform – as a member of the EURO-FAMCARE group is contacting and informing policy makers and NGOs on the European level and monitoring the development of actions for family carers. AGE aims to raise awareness about the issue of family care and to stimulate the political discourse.

Socio-Economics

A socio-economic evaluation, on the basis of the National Surveys and the pan-European background information, will calculate the economic conse-quences of family care, from perceived quality of life to European-wide politico-economic implications.


10

Transfer and Dissemination

The last step is a feedback research action phase based both on the study re-sults and on the pan-European expertise. A European Carers’ Charter in pro-gress will be further developed by the new European network organisation EUROCARERS in order to stimulate further activities both on national and European policy levels.

To promote wider and continuous transfer and dissemination, EUROFAM-CARE reports and results will be published in a series called “Supporting Fam-ily Carers of Older People in Europe – Empirical Evidence, Policy Trends and Future Perspectives”. The Pan-European Background Report is the first publi-cation of the series. The National Background Reports from 23 European countries – the basis of the Pan-European Background Report – will follow this publication.

We hope this will help to increase public recognition and support of all those who are caring for their elderly family members.

Hamburg, October 2005

Hanneli Döhner and Christopher Kofahl

The EUROFAMCARE Network

11

The EUROFAMCARE Network

The Members of the EUROFAMCARE Group

� Germany, Hamburg: University Hospital Hamburg-Eppendorf, Centre of Psychosocial Medicine, Social Gerontology, University of Hamburg (Co-ordination centre) – Hanneli Döhner (Co-ordinator), Christopher Kofahl, Susanne Kohler, Daniel Lüdecke, Eva Mnich, Nadine Lange, Kay Seidl, Martha Meyer

� Germany, Bremen: Centre for Social Policy Research / Centre for Applied Nursing Research, University of Bremen – Heinz Rothgang, Roland Becker, Andreas Timm, Kathrin Knorr, Ortrud Olessmann

� Greece: SEXTANT Research Group, Department of Health Services Management, National School for Public Health (NSPH), Athens – Elizabeth Mestheneos, Judy Triantafillou, Costis Prouskas, Katerina Mestheneos, Sofia Kontouka

� Italy: INRCA Dipartimento Ricerche Gerontologiche, Ancona – Giovanni Lamura, Cristian Balducci, Maria Gabriella Melchiorre, Sabrina Quattrini, Liana Spazzafumo, Francesca Polverini, Andrea Principi, Marie Victoria Gianelli

� Poland: Department of Geriatrics, The Medical University of Bialystok; Insitute of Social Economy, Warsaw School of Economics and Institute of Philosophy and Sociology, University of Gdansk – Barbara Bien, Beata Wojszel, Brunon Synak, Piotr Czekanowski, Piotr Bledowski, Wojciech Pedich, Mikolaj Rybaczuk, Bożena Sielawa, Bartosz Uljasz

� Sweden: Department of Health and Society, Linköping University – Birgitta Öberg, Barbro Krevers, Sven Lennarth Johansson, Thomas Davidson

� United Kingdom: SISA - Community Sciences Centre and School of Nursing & Midwifery, Northern General Hospital, University of Sheffield – Mike Nolan, Kevin McKee K, Jayne Brown, Louise Barber

� AGE - The European Older People’s Platform, Brussels, Belgium – Anne-Sophie Parent, Catherine Daurèle, Jyostna Patel, Karine Pflüger, Edward Thorpe

The Members of the Pan-European Group:

� Josef Hörl (Austria)

� Anja Declerq, Chantal Van Audenhove (Belgium)

� Lilia Dimova, Martin Dimov (Bulgaria)

� Iva Holmerová (Czech Republic)


12

� George W. Leeson (Denmark)

� Terttu Parkatti, Päivi Eskola (Finland)

� Hannelore Jani (France)

� Zsuzsa Széman (Hungary)

� Mary McMahon, Brigid Barron (Ireland)

� Dieter Ferring, Germain Weber (Luxembourg)

� Joseph Troisi (Malta)

� Reidun Ingebretsen, John Eriksen (Norway)

� Liliana Sousa, Daniela Figueiredo (Portugal)

� Simona Hvalic Touzery (Slovenia)

� Arantza Larizgoita Jauregi (Spain)

� Astrid Stückelberger, Philippe Wanner (Switzerland)

� Geraldine Visser-Jansen, Kees Knipscheer (The Netherlands)

The Members of the International Advisory Board

� Robert Anderson, European Foundation for Improvement of Living and Working Conditions, Dublin

� Janet Askham, King's College London, Institute of Gerontology, Age Concern, London

� Stephane Jacobzone, OECD, Social Policy Division, Paris

� Kai Leichsenring, European Centre for Social Welfare Policy and Research, Wien

� Jozef Pacolet, Catholic University of Leuven, Higher Institute of Labour Studies Social and Economic Policy, Leuven

� Marja Pijl, The Netherlands Platform Older People and Europe (NPOE)

� Joseph Troisi, University of Malta, Institute of Gerontology

� Lis Wagner, WHO - European Office, Kopenhagen

Every partner in the six core countries is also support by a National Advisory Group.

Introduction by the Authors

13

Introduction by the Authors

Many European and national reports have been written about the issue of care for older dependent people.1 This report is designed to focus on family carers of older people and their situation while later we consider how services do and do not help those who, in virtually every country studied in this report, provide a vast amount of care and support – those termed family and informal carers. It has been designed to be brief, to provide an overview of the 23 countries through their National Background Reports (NABAREs), and to act as a stimu-lus to all those involved in issues related to care.

The report rests on the expertise of the authors of the national reports and those interested in specific details for each country should examine these re-ports. Both the final draft of this report and the matrices attached to the report have been circulated between the authors for feedback and final adaptations. The country specific findings and suggestions were re-assessed in the context of the findings from the other NABAREs. We thank all authors for their addi-tional engagement in checking this report in order to improve consistency and reliability.

It is hoped that family carers, policy makers and service providers will find something of interest in this report and that it will provide ideas about how best to move forward in supporting both family carers and older dependent people. At the EU level, the family care of dependent older people is being increasingly recognised as a significant issue, related as it is to the three keystones of ac-cessibility, quality and sustainability of health care systems, to social inclusion and work (labour market).


1 Related studies and programmes include CARMEN, FELICIE, IPROSEC, OASIS, PROCARE,

SHARE, SOCCARE, European Observatory on the Family, European Foundation studies and re-

ports from these and WHO reports. See References.


14

1 Background to the Report

1.1 The EUROFAMCARE Study

In all EU countries, the responsibility for the provision of and payment for long-term care is divided between the four sectors of what has been termed the “welfare diamond” (Pijl 1994), namely:

� Family and informal care sector

� State or public sector

� Voluntary and non-governmental-organisation (NGO) sector

� Care market or private sector

The balance of care provision in each country depends on a mixture of factors such as tradition, legal responsibilities, health and social policy, national budg-ets and national wealth and, last but not least, demographic trends regarding fertility levels and life expectancy, which affect the availability of informal family carers.

There are substantive differences between countries in Europe as to how care is provided. Those with poorly funded welfare states and a continuing associa-tion between poverty and old age, such as Greece and Spain, are associated with low service provision limited to those who can pay or who lack alternative sources of care, whereas in those countries with very high taxation, such as Denmark, demand for services as a taxpayer’s right is high. However since demand is potentially infinite, even countries which provide services as a citi-zen’s right inevitably have to introduce a system of rationing, usually based on needs assessment (objective assessment of need for a service) and means testing (income and assets assessment of the older people and / or family car-ers) to ascertain the older person’s ability to make a financial contribution to payment for care. The former Communist regimes with their previous welfare infrastructures are gradually being reconstructed with a plurality of partners from state, local authority, NGO and private sectors.

Despite wide variations in systems of formal care provision for dependent older people, in all the 23 EUROFAMCARE countries the vast majority of care is provided by individual family members within the informal care sector. In countries such as Sweden, where the state has traditionally been a main pro-vider of care, the need to contain increasing costs2, in combination with the stated preferences of older people themselves to remain in their home envi-ronment for as long as possible, has led to what has been described as a “re-discovery of family care” (Johansson 2004). This involves various measures to 2 With a total tax pressure at 50% Swedes expect comprehensive care services and meeting addi-

tional caring costs by increasing income tax further would not appear to be a political option.

Background to the Report

15

promote and support the increased participation of the informal care sector via the public and voluntary / NGO sectors3.

The EUROFAMCARE study focuses on this major contribution of family carers of older dependent people in Europe to the overall provision of long-term care, by compiling comparative data on the situation of family carers through:

� National Background Reports (NABAREs) describing the current situation of family carers in 23 EU countries (AT, BE, BU, CH, CZ, DE, DK, EL, ES, FI, FR, HU, IE, IT, LU, MT, NL, NO, PL, PT, SE, SI, UK). http://www.uke.uni-hamburg.de/extern/eurofamcare/presentations.html

� A Pan-European Background Report (PEUBARE) based on the NABAREs and covering national and European policies and their implications

� National Surveys (NASURs) providing primary data on the experiences of family carers and service use, collected during interviews with 1000 family carers in each of the six core countries (DE, EL, IT, PL, SE, UK)

� A Trans-European Survey Report (TEUSURE)

� A Socio-economic Evaluation (ECO) and a European Policy Analysis

� Research Action (REACT), the final phase of the study, consisting of activities at the local, national and EU level, which aim to improve the situation of family carers

The aim of the NABARES was to collect systematic and comparable data on the situation of family carers in each country, based on a Standardized Evalua-tion Protocol – STEP (Annex 3), to facilitate the comparative analysis to be used for the production of this Pan-European Background Report. As a corol-lary to the STEP for the NABARES, the authors were asked to write three overviews with key points to be used for national and EU policy recommenda-tions in the final phase of the project and aimed at:

� Representative organisations of family carers and older people

� Service providers

� Policy makers

1.2 Data Analysis

Despite the use of a detailed Standardized Evaluation Protocol, the main prob-lem in analyzing the NABARES was both the lack of data on family carers from many countries and the wide variation in how available data were recorded, leading to non-comparability of findings between countries. Despite these diffi-

3 The voluntary/NGO sector in many European countries contracts with the public sector to organise

and provide services, thus acting essentially as an enterprise. This is distinct from the work of in-

formal, non paid volunteers.


16

culties, the authors have selected and focused on key aspects relating to care for dependent older people and some of the key issues which recurred in most reports and have tried to draw some conclusions on the present state of family care in those 23 countries, with a view to making recommendations for future policy for the support of family carers at both national and EU levels.

Family carers currently provide the vast majority of care for dependent older people in all the countries studied, with strong indications that they will con-tinue to do so in the foreseeable future. Thus, one of the main themes of the report are the different methods of support for family carers to give them choices in what aspects of care they provide, to enable them to provide care without damage to their own physical, mental and social well-being and to avoid long term poverty.

The short and long term outcomes and impact of the different types of support for the well-being of older people and family carers, as well as for national and EU economies, are also referred to, although these issues are examined in depth in the socio-economic and policy reports.4

1.3 Analytic Matrices

Using the data from the 23 reports, 8 matrices were developed as a way of analysing the large amount of data; these have been used as the basis for the report. The matrices include:

� Legal position of family carers and recognition by the state

� Labour force, informal and formal

� Home-based services for older people

� Services for the support of family carers

� Residential care

� Other issues

� Current policy debates

� Recommendations and future research needs

6 of these matrices are found in Annex 1, the matrix "future research needs" is in Annex 2, whereas "current policy debates" and "recommendations" have been incorporated into the text in sections 2.7 and 3 of the report.

4 ECO and the Social Policy Report

Background to the Report

17

Throughout the text, stars indicate brief descriptions of interest-ing, innovative or good practice. It should be noted that these simply provide examples from each country and are not meant to be an extensive and complete list. Full details of good practices can be found in the National Background Reports referred to and available on: http://www.uke.uni-hamburg.de/extern/eurofamcare/ presentations.html

1.4 What is Family Care?

The relations between people are based on social reciprocity, often reflected in legal contracts, and including obligations set up between people, typically kin, over a life time. Family carers of all kinds and of all ages, grow up with their society’s social norms and obligations. They also belong within a larger value and ideological system of political and religious belief – capitalism and free market systems, socialism, communism, Catholicism, Protestantism and Or-thodoxy, Judaism, Islam- which enshrine in certain dogma the values attached to care for one another, the role of the family and of women. The historic change in Europe has been towards the development of societies and econo-mies that offer people far more choices regarding the kinds of relationships they will set up (Giddens 1991).

Defining the nature of family care for older people who need a range of help with the activities of daily life and financial support is a complex one. Shared histories, love and mutual obligations are at the heart of an interpersonal social solidarity that provides both emotional and practical support between family members. The difficulties arise when the older person’s needs become such that they require help over and beyond these ‘normal’ interchanges. The sud-den onset of dependency following, for example, a stroke, requires an imme-diate response of increased support from both formal and informal care pro-viders. However, when dependency develops more gradually individuals tend to hardly notice the slowly increasing need for help. This is particularly the case for spouses where mutual dependency is often a well developed life strategy. The reports from the 23 countries indicate highly variable rates of spouse care which cannot easily be explained by marriage rates, the relative survival rates of men and women or patterns of co-residence. In countries pro-viding directly comparable data it was reported that in Spain 12.4 % of family carers were spouse carers, in the Netherlands 14 %, in the UK 16 %, 21 % in the Czech Republic, 29.2 % in Poland, while in Finland 43 % were spouse carers. In trying to explain such large differences in reported rates of spouse care, the way in which the research was conducted plays an undoubtedly sig-nificant role, depending both on the definition of care used and also on whether the person interviewed was the older person or child or spouse carer. Thus a spouse carer might see himself or herself as being the main carer, while their child might also respond that they provide a lot of care. Hence,


18

comparing percentages of spouse carers or data on child carers does not nec-essarily indicate significant differences in practice.

This is a necessary preamble to reading this report since the point at which individuals providing care, or the authorities that offer professional care, define an individual as being in a caring role vary substantially. For each individual the point at which they recognize that they are a family carer varies. The man who can no longer count on his wife being able to cook safely, may find this the point at which care becomes a burden; while a child may find dealing with a parent’s failing memory the point of irritation and burden.

What is family care? From the outset of the EUROFAMCARE study its clear definition was essential since it had direct implications for selecting the sample of family carers for the 6 national surveys. Thus, although the UK is unique in having a legal definition of who is a family carer which is supported by 3 Acts of Parliament, in the context of this study family care was defined as

“Care and / or financial support provided by a family member for a person 65 years of age or over needing at least 4 hours of personal care or support per week, at home or in a residential care institution.”

However, given the massive social changes in terms of work, the role of women, the size of families, the more frequent occurrence of non-marital part-nerships with unclear social and legal obligations, divorce and the reformation of families, the growth of single person households and the varying role of friends and neighbours, it is not surprising that the portrait of the ‘typical’ family carer emerging from discussions amongst the partners was as varied as peo-ple themselves.

Nonetheless, certain trends in family care might be expected, in line with more general socio-economic changes such as towards a more urban, educated population and to greater economic resources, even if older people them-selves may not always take the largest share in this. Other factors likely to af-fect family care are better housing and home conditions, social and techno-logical changes that already make home and personal care easier (e.g. ready made meals, home delivery, washing machines, telephones, central heating etc.) and the potential for new technologies to make even greater contributions to home care in the near future (smart homes, robotics, telemedicine). These socio-economic changes have occurred and are occurring at quite different rates in the various countries.

Key Issues

19

2 Key Issues

2.1 Demographic Trends

Who precisely provides family care varies substantially, relating in part to demographic developments that have occurred in each country. Demographic trends, including declining birth rates and increasing life expectancy, have oc-curred throughout the 23 countries. However, the exact time at which the birth rates declined in each country vary, with Hungary being one country that ex-perienced a low birth rate several decades ago and Ireland being a country with a relatively recent decline. This aspect of demographic change should not be ignored since it provides an understanding of the ‘stock’ of kin and family members available to care in the population both currently and in the future. Other demographic changes that have occurred also have a substantive im-pact on the availability of family carers. These include the decline in marriage rates, the rise in divorce rates (excluding Poland), the decline in the size of households and the increase in single person households and patterns of ru-ral-urban and international migration. Each of these factors, in addition to pov-erty rates and the distribution of income between the generations and age groups, occurs with variations between the 23 countries (2003 The Social Situation in the European Union. European Commission. Eurostat).

Belgium has taken the demographic projections seriously and, recognizing the baby boom and subsequent low birth rate, set up a Silver Fund to meet the needs for pensions and care as conse-quences of the ageing population after 2030.

2.2 Legal Obligations and Family Care and the Role of the State

The legal situation regarding care obligations within the family varied widely amongst the 23 NABARES countries, as did the enforceability of the law. Given that the law represents an enshrinement of specific social attitudes and expectations and is constantly being modified, it was considered important to review the very different situation of family carers in the 23 countries, regard-ing both responsibilities and rights.

Legal obligations to care consist of financial responsibilities and duties to provide practical “care”, although the two cannot always be clearly distin-guished.

Moreover, legal obligations to care are different for spouses and children

� Spouses have ethical and legal obligations to mutual support and care


20

� Children’s obligations are not as clearly defined as those of spouses, if at all.

However, changing social patterns across Europe, with the increase of “part-ner” relationships particularly in Northern Europe without the legal ties of mar-riage, may lead to different care obligations between partners, as well as part-ners’ children, and the increase in divorce and re-marriage is creating new family networks with an associated lack of clarity regarding obligations and willingness to care.

Legal enforcement of family care duties

The enforceability of laws regarding family obligations to support dependent members, depended on the type of support specified, although almost no country could cite any case law examples where the practical duties of families to care were legally enforced. Portugal was the country that considered case law existed for the enforcement of care by families, while in Poland there were joint legal inheritance agreements on inheritance in exchange for care. Spain also cited that infringement to fulfil legal duties to assist could be punished with arrest from eight to twenty weekends under the Spanish Penal Code, though how often this was enforced in practice was not clear.

However, legal enforcement of financial support by children for their depend-ent parents was reported by many countries with regard to family contribution to payments for care (AT, BE, FR, DE, IE (recently repealed), IT, NL, PL, ES, PT, SI, UK). This is achieved by:

� “Means testing” of the dependent older person and / or spouse and / or children to pre-determine their financial ability to contribute to the costs of care, e.g. in the UK, an older person must contribute to the costs of care if they have assets above a certain level.

� Reclaiming costs of care via means testing of children’s “inheritance”, e.g. in France, the state is legally entitled to deduct the costs of residential care from the dependent older person’s estate on death

In both cases the family's financial participation in the costs of care, if they are able to, is ensured. The practical provision of care by family carers, however, appears to be legally non-enforceable and, though spouse care would seem to be part of the marriage contract, care by children and kin is essentially volun-tary.

In summary, amongst the 23 countries, primary legal responsibility for the care of dependent older people was as follows:

1. Spouse care obligation specified, financial and / or care (AT, FR, HU-until the change in regime, ES)

2. Child care obligation specified, financial and / or care (AT, BE, BU, FR, DE, EL, IT, MT, PL, ES, PT, SI)

Key Issues

21

3. State / local authority (CZ, DK, FI, LU, NL, NO, SE, UK)

4. Unclear or variable legal rights (IE, CH, HU)

In 1 and 2, the state assumes responsibility only if the family is unable i.e. there is an obligation on the part of the older person to show evidence of the family’s inability to care, such as no family members available, financial or so-cial difficulties etc. There is no state obligation or incentive to provide needs assessment, but the older person and the family may be means tested to as-sess eligibility for service.

In 3, the state, whether at national, regional or local level, assumes primary responsibility, using varied systems to encourage or support family carers in sharing care. This implies that services are provided according to need (needs assessment), with or without a financial contribution (the older person and / or family are means tested).

2.3 The Role of Family Care and Social Attitudes

Attitudes towards family care vary throughout Europe, but also within the indi-vidual countries, e.g. urban / rural, middle / working class. Although an attempt has been made to classify these variations in attitudes towards family care, there is really a spectrum which is often also related to levels of formal service provision for the older person.

� High social expectations to provide care, no formal recognition FR, EL, HU, PL, ES, PT

� High social expectations to provide care, increasing formal recognition AT, DE ambivalent, IE, IT, MT, NL

� Low social expectations about family care, no formal recognition BU, CZ, DK, LU, SI, CH

� Low social expectations, increasing formal recognition BE, FI, NO, SE, UK.

At the individual country levels however, wide variations in the approaches to family care exist, exemplified even within the Scandinavian countries with their traditionally high levels of health and social care services.

The Danish approach is to focus on the continuation and expansion of ser-vices to meet the increasing demands of an ageing population, with little rec-ognition of the role that informal family care does or could play in future plan-ning. This approach reflects the similar policy for care of children, where high levels of female labour market participation are supported by high provision of public infant and child care services.

Sweden in contrast, despite similarly high levels of women working outside the home and of service provision for older people, is experiencing a “re-


22

discovery” of family care and has recognised the value of and need to support family carers, in combination with good and adequate services.

Many countries would envy the efficiency of Sweden where the development and implementation of a 3 Year Action Plan (1999-2001) stimulated Local Authorities to develop an infrastructure of services targeting family caregivers, e.g. by setting up caregiver resource centres offering training, counselling, support groups, respite care, in-formation and resources for family caregivers, including day care programs for their disabled family members.

Interestingly, in Norway, where very detailed information is available from specific projects on who undertakes different caring tasks for the support of dependent older people, women in paid work are reported to provide more in-formal care than non-working women. Nevertheless, the role of the Norwegian family carer is considered to have a supervisory nature rather than providing regular “hands on” care, due to high levels of service provision, although the Action Plan for the Elderly specifically underlines “the importance of taking care of and supporting the caregiving ability of families.”

In Finland a significant part of daily activities (cleaning, shopping, laundry etc.) for older people living at home, including the very dependent, is undertaken by relatives either with or without public support. Without family carers there would be a lot more pressure for institutional care and there are indications that older people would like to give more responsibility to relatives for their care. The importance of family caregiving has been noted in Finnish society by policy makers.

The administrator appointed by the Finnish Ministry of Social Af-fairs and Health, recently (March 2004) made a proposal contain-ing 16 recommendations involving family carers’ well-being, pay and leisure as a way of developing the status of carers as part of social and health services. The aim is to give the family caregiver the status of a municipal worker, with these changes being intro-duced gradually and completed by 2012. Services are mainly pub-lic with the municipalities contracting to private agencies to fill the gap between demand and supply.

In summary, the “Scandinavian model” of care, based on a high level of ser-vice provision, in fact displays 4 different examples or models of care for older people when viewed from the perspective of the family carer.

A quite different model is being developed in the UK, Ireland and the Nether-lands where family carers are being recognised as a group of citizens with special rights.

Key Issues

23

The UK is unique in giving legal recognition and associated rights and services to family carers, enshrined in the Carers’ (Equal Opportunities) Act 2004.

At the other end of Europe, the “southern European” or “family model” of care, exemplified in EUROFAMCARE by Portugal, Malta, Greece, Italy and Spain, also displays broad differences in developing services and support for older people and their family carers in response to demographic and social changes. Traditionally, Portugal has many women in the paid labour market and as a result makes more use of residential and home care services for very depend-ent elderly people; this contrasts with Greece with a low labour market partici-pation rate of women, a low use of residential and home care services and a turn to using migrant care workers by those who can afford it.

2.4 The “Work” of Caring

2.4.1 Family Carers

Family carers were rarely considered in the 23 countries as part of the paid labour force, with the main focus of interest and data being on the potential and actual impact of family care on labour market participation. Nonetheless family carers do provide their labour, mostly unpaid, to support the dependent older person; the supply, availability and willingness of individuals to act as family carers is critical in understanding the long term trends in labour provi-sion for care work. The difficulty revolves around the unpaid and unrecognized nature of domestic work – a problem faced by economists and statisticians. Is family care and domestic maintenance part of the national economy or not? Where this work is undertaken by paid persons it is counted as falling within the labour force, though not when unregistered.

As might be expected, the Swiss have studied the economic value of family care work, which they calculated to reach between 10 and 12 billions of Swiss Francs, exceeding the cumulative spending on both home care services and residential care homes.

Thus the rate of women’s participation, or non participation, in the labour mar-ket is often a dimension of labour availability for care work. The critical issue in the labour market for care work lies in whether the individuals providing do-mestic and care work are officially paid with national insurance and tax contri-butions or not. The debate also revolves around the ‘work’ people do to sup-port one another, as part of normal social exchanges, and that which goes be-yond these ‘normal’ interchanges to become defined as ‘work’. Only a few


24

countries have provided any estimate of the total amount of time and thus ‘work’ provided by family carers – Norway reports that care for those over 67 years of age takes approximately 49,000 man years per annum. Yet this in-volves all kinds of care and rarely in the national reports or literature is suffi-cient distinction made between ‘normal’ care and support, and the labour in-volved when people become very dependent. Nonetheless data on dependent older people shows that in many countries (AT, BE, IT, CZ), 70-80 % of care was given by family carers. This contrasts with data from Denmark that shows that less than 55 % of older people get family care support.

Data from national studies on the proportion of the population giving care are not very helpful for comparative purposes, since the nature of this care, the size of households or which ages are counted as being potential family carers varies widely, ranging from the whole population to those aged 16 or 18, with variable cut off points, e.g. aged 65 or age 74. An example of this kind of diffi-culty in comparing data can be seen when examining the data on Portugal where 2.3 % of the population are reported as caring for an older person, Spain, where 5 % of those aged 18+ are reported as providing family care to a dependent older person, equivalent to 12.4 % of households, Switzerland, where 23.1 % of the population are reported as caring for someone aged 65 and over, and the Netherlands, where 18.8 % of the population 18+ (2 million) report caring for someone 64 years and above. Some of these differences in rates of family care between countries are frankly counter-intuitive.

The national reports provide indications that even within countries there are often massive variations in the amount of family care provided; UK, Ireland, Italy and Spain report such significant variations, e.g. more in the South than the North of Italy, and more in Northern England than London, while other counties report large urban-rural differences. Thus the difficulty does not lie in the accuracy of national data per se but the lack of comparability in studies and the criteria used to measure family care.

2.4.2 Characteristics of Family Carers

Given some of the specified problems in defining family carers, what does emerge in many reports is the predominance of women, whether as child, sister, spouse or friend / neighbour carers. Though the rates vary, overall ap-proximately two thirds of care5 is provided by women. However, where data are available for care for the most dependent, the numbers of women carers rises, e.g. in Italy, the proportion rises from 66 % to 81 % for heavy care, while for those receiving allowances, normally awarded for the care of the most heavily dependent, the figures from Luxembourg and Spain show figures of 94.2 % and 83 % women respectively. In Germany, amongst the terminally ill 81 % of family carers were female: wives, daughters or daughters in law.

5 66.33% BE; 64% CZ; 75% FI; 75% PT: 69-74% MT; Women give 2.5 x more care than men NO.

Key Issues

25

Amongst these, 32 % were also in paid employment with the proportion for daughters being 61 %; 87 % of them additionally were responsible for their own household. This kind of pressure on women inevitably had repercussions on their own mental and physical health and this is discussed later.

Yet where care is provided by older people to each other, then there is a greater gender balance: Poland and Switzerland reported equal proportions of male family carers in the 50+ age groups while the UK reported no gender dif-ferences in family care for co-resident carers, though women do more care in another household in both Switzerland and the UK. In Italy, 10 % of family care was provided by people who were themselves over 80 years of age.

Although in many countries children, especially daughters and daughters in law provide a large percentage of family care, e.g. nearly 75 % were child car-ers in Malta, there were large variations. In Hungary, daughters constituted 11.3 % and sons 8.7 % of all family carers compared to 37.1 % daughters and 20.9 % sons and 15.5 % grandchildren in Poland.

Social changes in marital and family relationships in Europe are often as-sumed to have implications for the availability of family carers. In the case of spouse versus other forms of non legal partnership, the data from the national reports was not clear; thus no valid reflections can be made on this issue in this report. Demographic differences between countries may account for some of the variation in who cared; sibling care, especially by sisters, was pointed out to be important in Slovenia. However, in examining the variations in who provided care in a range of countries where data are available, the role of the wider family, neighbours and friends, was evident. In Spain, relatives other than parents, spouses and in laws provided 14 % of care, while neighbours and caretakers provide 5.6 % and friends 4 %; in Hungary in rural areas 19.2 % of older people relied on friends and 34.4 % on neighbours; in the Czech Republic 16 % relied on friends and 10 % on other relatives while in Belgium the wider family cared for 17 % of dependent older people needing care while non-family carers were responsible for 13.3 % of care.

The age of the carer, the current state of the labour market and women’s par-ticipation in the labour market all appeared to have a direct influence on those who both worked and cared. There were a number of countries marked by the high rates of labour market participation (80 %) for women until the age of 55 years, including CZ, DK, PT, SE and FI. This was reflected in the fact that a large proportion of carers were employed; however, again one should be care-ful as the degree of dependency of those they cared for was often less than in other countries. Thus in Portugal at a certain level of dependency it appeared that older people went into residential care, while in Sweden and the Czech Republic there were a variety of forms of residential support for those who could no longer easily be cared for at home. As suggested, the percentage of those using any and all forms of residential care has to be considered in order to understand the ability of family carers to hold down full time jobs. In addi-


26

tion, the hours given to care must be carefully examined, with the suggestion that working carers probably give fewer hours to care. This compares with fig-ures for Spain where 22 % of family carers were employed (36 % part time and 64 % full time), or Poland where a third worked and cared.

In several countries family carers were reported as being more likely to be housewives, pensioners or unemployed (BE, EL, DE, ES). Germany reported that civil servants, the self employed and the salaried were those in the labour market who were most likely to combine work with care, though overall those caring for older people without dementia were more engaged in the labour market (30.9 %) than those caring for a person with dementia (25.3 %). In Switzerland, 33 % of the self employed provided care, while 21.8 % of the un-employed did so. Ireland brought some interesting data to show that despite the huge increase in labour participation rates for women (50 %), they contin-ued to do the same amount of caring as the non-employed. Such data sug-gests again the difficulties of unravelling the concept of care. Those who work may be far more inclined to notice that they are also caring than those who do not work. The decline in rates of employment for women, especially in the Eastern European countries, has implications as to the availability of people to care, e.g. in Slovenia, though also in France. Yet internal and external migra-tion, e.g. in Bulgaria, Hungary, and Greece may leave many older people with fewer available carers.

The economic aspects of family care are also reflected indirectly in the infor-mation from Austria that amongst the 40 % who were employed and cared, those with low status jobs were more likely to undertake work and hands on care. In Italy, family carers tended to have more available income than non-caring households yet 60 % were unhappy with their economic situation; these data probably reflect the pooling of resources by the family carer and older person in a common budget.

There are often considerable details on the average age of carers – yet as al-ready indicated the (self-) definition of family care makes such data problem-atic in a cross country review.

The trends observed by national experts are important in deciding on the fu-ture availability of family carers, all other matters being constant6. Several countries perceived a trend in the decline in willingness to provide hands on care especially amongst the better educated and those with better jobs (AT, DE, NO) and this was also noticeable among women, where the large in-crease in the numbers working and / or the availability of long-term care insur-ance (LCI) allowed many to retreat from care (FI, IE, DE, MT, NL). Belgium noted the increased mobility in society, making family care less available, while Hungary and Malta noted the trend that older people and family carers

6 Of course they are not constant. Thus in Sweden the decision to support family carers may in-

crease the numbers of people offering care to dependent older people.

Key Issues

27

less often share a common household. A number of countries commented on the increase in the numbers of male carers (HU, EL, IE, IT, MT, SE) and Nor-way and Sweden noted that the total amount of family care has increased though the hours spent has decreased, which is in line with the provision of more care services. Finally, some authors commented on the changes in atti-tudes amongst older people; some perceived their families as less willing to care (BE) and others, including the Netherlands, suggested that there was evi-dence that the better educated preferred public and private services rather than help and care from their kin.

2.4.3 Is Family Care ‘real’ Work?

Studies from various countries provide some perspective on the number of hours for which family carers worked to support dependent older people. In Portugal, 68.3 % of family carers provided more that 4 hours per day and 56.6 % provided care every day. In Ireland, the breakdown of hours provided by family carers showed that 60.3 % worked 1-19 hrs, 13.4 % - 30-49 hrs and 26.7 % more than 50 hrs per week. Luxembourg, which provided a detailed breakdown for the hours of care given to dependent people of all ages indi-cated that the young disabled needed most care followed by the oldest age group (90+) and that overall 35 % of dependent people needed in excess of 24 hours per week. In the Netherlands, the average amount of care amounted to 17.9 hours per week, including domestic help, psychosocial support and per-sonal care. These indicative numbers suggest that taking on the care of someone means for many people to invest a lot of their time and perhaps a half of all carers have, effectively, the equivalent of a half time ‘job’. For the most dependent, including, for example, those with dementia or those at the very end of life, the hours needing to be spent in care rise substantially. Unlike the care of children, family care of dependent older people cannot be pro-grammed precisely. The gradual nature of increasing dependence is the usual scenario, though not even this is predictable and age related decline in func-tional ability may include significant periods of decreased or increased de-pendency (Robine, Romieu, 1998). The lack of ability to ‘programme’ the work needed is one of the characteristic problems of family care work with older people and, indeed, care from service providers7.

Another aspect that reflects on the nature of the work of a family carer is the issue of its consequences to their health and well being. As already discussed, the levels and types of care provided in countries varies, but given that in many only inadequate services to support both older people and their family carers exist, what does emerge widely from the reports is that the provision of care has both physical and mental consequences. France reported that family carers had double the risk of depression than in the general population, a find-ing that is supported in other countries where depression and psychological 7 Hence the interest in discussions on the cultural as well as the health aspects of dependency.


28

burden were noted as being very frequent. In Portugal, where depression was also an issue among family carers, the report also indicated that needs and problems vary by income levels, with leisure being more of an issue for the better off and financial help for the worse off.

Also commonly more frequently reported amongst family carers than for the general population were physical problems that were consequences arising from care. For example, the German report states exhaustion, pain in arms and legs, bad backs, heart trouble and severe stomach pain. These symptoms were more pronounced amongst those caring for the cognitively impaired. So-cial isolation and the inability to participate in normal family and social life, mentioned in the Slovenia report, is undoubtedly a widespread phenomenon. For care-providing ageing spouses, fears of what would happen if they died or could no longer manage, was a specific issue mentioned in the Danish report, but probably a common theme for spouse carers in many countries; the Neth-erlands noted that spouse carers were less likely to use services, though car-ing full time, while Norway reported health risks for older people providing long term care for spouses with dementia.

One aspect of family and professional care that helps in understanding the na-ture of the work and particularly its emotional consequences is that which con-cerns abuse. Most countries have no or very little data on the issue8. Slovenia reported research that found a staggering 50 % of older people were abused by their children, with family members or relatives being responsible for three quarters of incidences of abuse and the explanation being found in the exhaus-tion of family carers, although 10.9 % were also abused in the institutions where they lived. The Scandinavian countries provide figures for elderly abuse that vary from 1 % to 8 %, with abuse more common in urban areas. In one study in Germany, 10.8 % of older people, disproportionately older women, reported violence against them, though psychological maltreatment and financial abuse were more frequent. In the Italian report, reference was made to recent re-search monitoring 2,500 people aged over 60 in a number of European coun-tries; Italian older people were those reporting most loneliness and neglect for which they held their children responsible9. Domestic violence is generally hid-den.

A study in the UK indicated one in three old people were psychologically abused; one in five physically abused and the same number has their savings inappropriately used; more than 10 % are neglected and 2.4 % sexually abused. There is also only limited data on abuse of older people in residential care.

8 In addition, data is often not comparable since the research definitions used vary.

9 Like dependency, this is often a matter of cultural and individual definition.

Key Issues

29

In Italy pioneering projects in Turin, Rome, Milan and Genoa sup-port elderly victims of abuse as collaborative ventures between municipal authorities and local voluntary agencies.

Germany and Italy point to the fact that there is also inadequate data on abuse by older people against their family carers.

What is important to underline is that interpersonal relations may become very tested when dependency becomes a characteristic within the relationship. In-terventions in such situations require a well developed and proactive psycho-logical service and it may be more effective to provide more respite care than to try to alter the relationships between the family carer and older person.

The Czech Alzheimer Society started a new project, “granny sit-ting”, that provides family caregivers with regular respite.

In the general framework of training for all carers, the issue of dealing with an-ger, frustration and difficult interpersonal relations should also be confronted.

In Malta, where the Catholic church is important, two church-based organizations give training called “Care for Carers” de-signed to reduce stressful situations, improve communications, as well as provide care in a more effective and efficient manner.

In discussing the issues of the hard and difficult work of family carers it should not be forgotten that many obtain satisfactions from their caring work; interest-ingly this aspect rarely emerged in the research quoted in the national re-ports.10 The UK was one exception to this; studies which included minority ethnic groups indicated that the extent of care giving satisfactions outnum-bered the difficulties with the dynamics of the relationship between care giver and older person being the key factor.

The value arising from the recognition that the work provided by family carers often has real health and social costs for them, lies in considering which ser-vices can best relieve and support them, e.g. in confronting depression, in re-ducing the physical toll and social isolation. Another aspect is that some of the same issues may also arise when considering care work conducted by profes-sionals; learning specific skills and having appropriate practical and psycho-logical support may play significant roles in helping both family and profes-sional carers.

10

This is likely to be the result of consistent value judgements by researchers who focus on burden

rather than satisfactions.


30

In Slovenia, the Anton Trstenjak Institute provides intergenera-tional communication programmes so that family members are trained to better understand older people. This has several bene-fits; the quality of life of older family members is improved, eve-rybody is more pleased due to better family relationships and younger generations become familiar with old age, the first step in preparing for their own ageing.

One such form of support that plays a highly variable role in some countries is that of family carer support groups. While some groups are particularly con-cerned with advocacy for their rights and the conditions under which they work, many are also important in providing psychological and practical support to one another, e.g. the Alzheimer Society or the Federation of Senior Citizens Organisations – BAGSO – in Germany. As discussed below, such groups may be supported and encouraged by national and local governments.

2.4.4 Reciprocity in Family Care Work

Property, savings and life time exchanges between the older person and the family carer have to be taken into account when examining the willingness of individuals to take on care. While not the primary motivation from the perspec-tive of the family carer, it may still play a significant role in the reasons people feel there are obligations to care, though there is limited research on the sub-ject. Research in Norway indicated that despite the fact that there are consid-erable transfers from older people as inheritance, pre-inheritance and gifts, this did not generally influence the amount of care given to older parents by children. If parents are in need of nursing, previous practical help from parents to children, including child care, resulted in more nursing care by children. Overall older people gave more help and economic support to the younger generations, compared to the help they received. The German report stressed that moral obligations and financial considerations are not mutually exclusive in family care. In three countries, Belgium, Denmark and Finland, property and savings were said to play no part in family care. In Spain, 63 % of family carers indicated that the older person gave them no economic rewards, 23 % regu-larly received compensation and 13 % occasionally; but the overall costs to the household of providing care were substantial, especially those with a medium-low economic status, since pensions are low and do not even cover the costs of care.

Overall in 15 of the country reports property and economic transfers were stated as playing some role in family care. In Austria, one study showed that 72 % of family carers considered transfers to be important and only 28 % felt that inheritance plays "a negligible role” in inter-generational relations. In Bul-garia, Poland and Italy, inheritance was important and if a family took the older person’s property and then did not provide care the state intervened. In three countries, Hungary, Slovenia and Poland, explicit mention was made of the

Key Issues

31

value of the older person’s pension to the carers, given the high rates of un-employment. Slovenia, Ireland and UK mentioned that older people often want to be able to pass on their property to their children, leading to reluctance to seek other kinds of care solutions or support which would involve them selling their assets.

With reference to long term trends in willingness to care, it is necessary to consider if such exchanges and inheritance are likely to continue to be impor-tant. It may be presumed that where the older person offers a scarce eco-nomic resource this aspect will continue to be significant, though much less so where their children have their own resources. One hypothesis might be that older people either with resources or, as the Portuguese and Norwegian re-ports indicate, who have given a lot of time and energy to the practical support of their children, are more likely to receive care.

2.4.5 Professional Paid Care

In discussing services to support older people and family carers, the availabil-ity, training and qualities of all those employed to work in the care sector need to be considered, since they provide the context in which family carers can genuinely rely on support and help in their work. Care work in both residential and home care services is overwhelmingly being provided in the public sector. Nonetheless the growth of organised private sector services was reported in Austria, Finland, Germany, Greece11 (very limited), Ireland, Italy, Luxembourg, Netherlands, Norway, Poland, UK and Slovenia. While it is probable that these private services are more used by the better off amongst older people and their families, few countries reported large differences between the public and private sectors in terms of their attractiveness to care workers or in terms of their ability to recruit and retain care workers. Of particular interest are those countries that reported few problems in recruitment and retention of care workers in either the public or private care sector, e.g. The Netherlands, Bul-garia, France, Luxembourg, Malta, Poland, Portugal. Others, like Belgium, have had a problem and are attempting to improve the supply of nurses and care workers by improving working conditions and pay, while in Denmark simi-lar attempts are being made by improving training and attempting to attract more men into caring jobs with older people. All these positive examples are important since they suggest that there is nothing inevitable about the difficul-ties reported in so many countries in recruiting and retaining care workers for older people.

What are the main difficulties reported in the national reports? These include low pay in Finland, Austria, Greece Hungary, Ireland, Poland, Portugal, UK (especially unqualified staff); the lack of staff leads to unacceptable shift work

11

Reference here is to organised services rather than the growth of migrant care workers who are not

normally organised into a service.


32

and overtime in Austria, Slovenia and Germany, while Poland believes this is a future problem they will face. The low prestige and tiring nature of working with older people was commented on for the Czech Republic, Germany, Greece, Hungary, Italy, Ireland, Sweden, Switzerland and the UK. The lack of a real career and promotion opportunities was commented on by Ireland. Even in Norway there was a high turnover amongst care workers in the urban areas. The predominance of women in care work was a feature of every country – a characteristic that is nearly always associated with lower pay and prestige. In the Netherlands, professional care workers in residential care have increas-ingly limited time for every patient, due to budget cuts. Increasingly volunteers and family carers are needed to provide care in residential and nursing homes.

Thus one of the critical issues facing most countries is how to improve the status, conditions of employment and attractiveness of working in the care sector for older people in the many countries where care workers are often undertrained and overworked. This is a difficult issue given the fact that public budgets in most countries tend to be limited, unskilled and semi-skilled labour is often readily available and cheap, while the perception and often the reali-ties of work with older people is that it is depressing and hard. Clearly, as some of the 23 countries have managed to improve the status of care work, there are lessons to be learned about how this may be achieved.

One way forward is training, in combination with the development of a ca-reer structure for care workers. In turn, this requires that all services intro-duce quality standards.

This may be one arena in which interventions from the EU could be a positive influence, e.g. the promotion of minimum standards in care work and ensuring that some EU funded training schemes are devoted to care work. Several countries noted that in private services care workers were often less trained than in the public services.

In Portugal training the long term unemployed to work with older people in a social support service was developed.

In Hungary, with its long-term low birth rate and fewer children to care, NGOs have been active innovators. The Budapest Centre of the Hungarian Maltese Charity Service linked a two year health and social training to the employment of disadvantaged young girls and boys living in poor family circumstances with emotional and family deprivation. On graduation the young people took jobs in care and nursing for older people where they also functioned as quasi grandchildren. The same NGO has also supported the development of networks of voluntary and neighbourhood carers to cope with age-related disability.

Key Issues

33

However, caution is required in extrapolating from these suggestions and ex-amples; the French report indicated that unless there are clear advantages in terms of employment and promotion for those with qualifications, and while public and private bodies continue to hire the unqualified at similar rates to the qualified, individuals may perceive no real advantage in gaining qualifications.

The modernisation of services and institutions represents an important way of moving forward in making care work more attractive; thus, introducing new technologies where possible and training both family carers and profes-sional staff would appear to be a positive step forward. Given the under-funded nature of many public and private care services this may not always be feasible, but must be considered as a possible strategy at national level.

Making the conditions of employment more attractive is another device to attract and keep care workers; genuinely flexible forms of employment12 from the perspective of the employee may be attractive to some individuals. Swe-den reported using increasing numbers of part time workers in both home and residential settings, reflecting contradictions between stakeholders – what is good for workers may not be good for older people, e.g. with respect to conti-nuity of care.

In Belgium a federal initiative Integrated Services for Home Care (GDTs) help family carers by organizing multi-disciplinary consul-tation and by helping them to draw up a realistic care plan that specifies the tasks of each (formal and informal) carer.

Another area for possible improvement lies in changing attitudes towards older people and perhaps of older people towards care workers. The experiences of possible attitude changes in Austria, Germany and Hungary, where young men may work in care settings for older people instead of doing military ser-vice, would be interesting.

In Denmark the attempt to make care work more attractive to men is one strategy that needs to be monitored.

2.4.6 Migrant and foreign Care Workers, legal and illegal

De facto solutions to the recruitment of care workers for older people are being found in 13 of the 23 countries (AT, CZ, DE, DK, EL, IT, LU, NO, PL, ES, PT, CH, UK) by the use of migrant and foreign care workers, as domestic, care or nursing personnel. As is evident, this solution was being used in a wide range of countries in terms of both income and welfare systems. There were no data 12

Marrying the interests of services, e.g. the need to organise shift work and 24 hour coverage, can

be done in conjunction with the wishes of employees for flexible and/or part-time employment.


34

for France, but migrant workers were apparently important and for Ireland mi-grant workers were important in the nursing sector. Belgium and Sweden pro-vided no data. The countries reporting that migrant labour was not important in care work were FI, BU, MT, NL and SI, and only a few reported that foreign born people were less likely to be employed in health and social services; The Netherlands pointed out that a significant impediment for entering this part of the labour market is the requirement for higher education and the poor com-mand of the Dutch language. Recently, in the Western, urbanised part of the Netherlands more migrants are working in the lower care jobs.

One of the difficulties associated with migrant care workers is that though many may be more educated than local care workers, they are rarely trained in care work per se and may have language problems. Many governments, sim-ply by not developing public services and by not having active policies towards the recruitment and legalisation of foreign migrant care workers, are conniving with the current situation which leads to exploitation and a lack of control13. Ensuring their legalisation, training (including language), and their incorpora-tion, where feasible, into a caring career, is likely to be important for the com-ing years until attitudes and practices change substantively in many of the countries reviewed.

2.4.7 The Voluntary Sector

A large number of countries had and have sought to develop volunteer ser-vices to help with the care of older people and indirectly for family carers. Aus-tria, France, Belgium, Bulgaria, Hungary, Ireland, Finland (1 % of all care), Germany, Greece, Italy, Malta, Netherlands, Poland, Slovenia, and the UK all reported that volunteers were important in caring for older people, while Swe-den and Norway specifically mentioned the importance of volunteers but not for hands on care. One outstanding example is Hungary, where 70,000 NGOs have developed in the past years, 13 % being in the health and care fields. Here volunteers work at lower wages than employees but undertake hands on care. This contrasts with the situation in most countries where volunteers do not undertake a lot of hands on care, but provide important auxiliary services such as transport, accompaniment, social support etc. In a number of coun-tries, family carers’ self help groups are also important in terms of offering practical care support.

13

It may well be argued that the private solutions adopted by the middle and upper classes by em-

ploying migrant care workers contributes to the lack of political concern with the general situation of

family carers.

Key Issues

35

In Germany the Department for Social Work in Wiesbaden (Hes-sen) runs a course qualifying people as "voluntary senior citi-zens’ companions" designed to lessen the burden of care and give support to family carers in need of a few hours of free time.

In the Netherlands the national organisation for Voluntary Pallia-tive and Terminal Care (VPTZ) with 180 local VPTZ-organisations has a well-developed training course for volunteers who are pro-viding palliative and terminal care at home and in hospices to re-lieve family carers.

In contrast, volunteers played a very limited role in both Spain (0.1 % in care for older people) and Portugal. No data from national reports indicated whether organized volunteering substantially relieved family carers, although in Ireland, 12.5 % of all volunteers provide services for the sick and older people.

2.4.8 The Future of Care Work

The above analysis suggests that the care of older people will continue in many countries to rely heavily on family carers, supported by professional care workers and this is probably in line with the wishes of some family carers who want to care. The overwhelming majority of public budgets can currently not bear the full costs of developing a system of comprehensive care for older people through publicly provided services, especially since future predictions indicate that the demand for care is likely to increase. Thus ensuring that fam-ily carers are supported by professional care workers is critical, as are policies and practices that compensate family carers for care undertaken by ensuring that they retain a good quality of life and security in their own retirement. Both these aspects are critical elements to be addressed in policies for family car-ers.

In Ireland the development, promotion and adoption of the Carer’s Charter marks an attempt to recognise publicly the work and the rights of family carers.

Family carers’ recognition can be further promoted through the development of training and changes in attitudes that will ensure that all care workers learn to perceive family carers as vital members of the care staff, with rights to leave, respite care, advice, information and training.


36

The German Federation of Advice Centres for Older People and Family Carers (BAGA) published a manual for professionals on how to give advice and support to family carers of older people suffering from dementia, including practical training, support groups for older people suffering from dementia, advice and counselling in domestic care environment, volunteer services, café for family carers and Alzheimer-dancing-café sessions. The reader also contains comprehensive information on family caring and relevant legislation.

The systematic training of family carers could be another important develop-ment, particularly in creating professional attitudes towards care work and en-suring good standards amongst family carers and safeguards for their own health and well being, although their parallel need for adequate support ser-vices in the provision of care should also be emphasized.

In the Spanish autonomous province of the Canary Islands, the “Programme for the Elderly at Risk” includes support to carers offering training activities to 100 % of carers and community sup-port plans for self-help groups and associations.

Such training may also provide a future supply of care workers who after quali-fication may wish to work in this sector. Another important resource, not fully explored in most countries is the use of more part time care workers in both home and residential care settings.

A further development in the coming years will be the increasing numbers of older people from ethnic minority backgrounds. A number of countries have already developed services for them and some have also recognised the needs of migrant caregivers.

In Germany, concern with migrant family carers is evident in a number of courses being run throughout the country, e.g. a care-giving course in Wiesbaden is offered to Turkish migrants in Turkish and German.

2.4.9 New Technologies

New technological advances have neither been fully developed nor had yet an extensive impact in supporting care work with older people. This is partly due to the low levels of computer literacy amongst many older people, including family carers, and partly due to the difficulties of using new technologies in old homes. The ‘smart’ house is still a number of years from real implementation, though in countries like the Netherlands alarm systems and ICT-technology

Key Issues

37

are becoming standard equipment. The Italian report indicated that those who could afford it were paying for expensive new technologies including security alarm systems, video-telephones, mechanized shutter locks, tele-medicine de-vices, mechanised doors / window openers, data networks (for rapid shared access to the Internet), bedroom intercom, visual and auditory signals, remote control apparatus of certain functions via phone. A number of countries includ-ing Finland, Germany and the UK are working to develop gerotechnology, e.g. locomotion devices in / out of house, assistive technologies for eating and other activities of daily life, security, e.g. timers for lights, locomotion recogni-tion, security telephone, doorbell alarm, night alarms that wake the family carer if the older person moves from their bed in the night etc. Many countries are seeing the introduction of information and counselling systems designed to be used by family carers and professionals, whether run by local authorities, NGOs or family support groups.

In Sweden a telematics intervention programme (ACTION) has been devel-oped to support family caregivers of older people. The service consists of edu-cational caring programmes, video phone facilities for on-line communication with other carers and a call centre staffed with professionals an access to the Internet. The ACTION service has so far covered 40 families who are very sat-isfied with this type of support. (Magnusson 2005)

However, cheap and effective solutions such as the Hungarian alarm system between the older person’s house and a neighbour are probably the closest many older people and family carers currently get to using and accessing ‘new’ technologies!

Public investment in all forms of gerotechnology is important for the work of family care and the support of dependent older people14. However changes in mainstream developments can also have important implications for family car-ers. Thus, as both the Greek and French reports point out, cheap mobile phones allow family carers to be in constant communication with the older de-pendent person. Market penetration of most new technologies aiding family carers will initially be limited in many of the 23 countries due to low incomes. As in all innovations there are both benefits and potential abuses in the use of IT in care work, e.g. the ethical dilemma of constant observation.

2.5 Public Investment in Care and Family Care of Older People

2.5.1 The Right to receive Care

The right to receive care in times of illness, either short or long-term, is now agreed to be a fundamental right within the EU, enshrined and reflected in na-tional laws and the EU Social Charter. Whilst the 23 NABARES countries all

14

The EU is supporting a number of R&D initiatives that may help with care work e.g. smart toilets.


38

provided a basic health care system at the hospital and primary care levels much wider variations in the provision of social care services to older people exist, particularly in regard to home care services and whether these were provided as a statutory right, depending on need (degree of dependency) and financial situation (means tested). The increasing demand by ageing popula-tions in Europe for long-term care for chronic conditions causing disability and dependency emerges as one of the major trends examined in the NABARES reports, with focus on the main issues of who provides care, where is it pro-vided and how is it funded. There are significant inequalities and fragmentation in care provision as long-term care may be provided by either health or social service sectors or both. All 23 countries undertook some responsibility for the care of dependent older people, although there was great variation in:

� The degree of public responsibility

� Limited, e.g. only for the most disabled, those without financial means, and without family support

� According to need

� The type of public support available

� Financial support to the older person or the family carer

� Services to the older person

� Services to support family carers

� Length of time for which support is provided, e.g. Czech long-term care units put a limit of months on residence, in Greece the Urban Workers Fund limited public funding for nursing or clinic care to 6 months.

The public sector is increasingly funding and arranging the financial coverage for care but devolving at least some aspects of hands on care to others, be they voluntary, private or family carers, e.g. Hungary has seen a major expan-sion in NGO provision, the Netherlands leaves it to the older person to arrange what type of care they seek.

2.5.2 Approaches to Carer Support

How can family carers be supported to continue providing care at home for their dependent older people without adverse effects on their own physical and mental health or without long term consequences for their income?

In the NABAREs reports the following areas were examined:

� Financial support including payments / benefits (services in kind and services in cash), social and accident insurance and pension contributions

� Services to the older person

� Services to the family carer

Key Issues

39

As discussed in section 2.2, the variations in social care provision in the 23 national reports appeared to depend largely on whether the state took primary responsibility for the care of dependent older people, or only by default when there was no or inadequate family to care. In the latter case, seeking help from the state automatically implies a “deficiency” in the socially preferred form of family care, which in itself is perceived as reflecting an older person’s “value” to society, earned by having and bringing up children within society’s expected norms and values. In general, countries where the state takes primary respon-sibility for care of dependent older people also have higher levels of service provision (DK, FI, LU, NL, NO, SE, UK), but not exclusively, since several countries in which children have the primary responsibility for care still have quite high levels of service provision (AT, BE, BU, FR, DE, MT, PT).

2.5.3 The Rights of Family Carers and their financial Recognition

A number of countries have introduced public financial payments in the form of benefits or long term care allowances to help with the care of the dependent. These may be paid either to the family carers who provide the care as in AT, BE / Flanders and Brussels, CZ, FR, HU, IE, MT, NO, PL, ES, PT, SI, SE and UK, or they may be paid to the older person to pay the person providing the care service (NL and DE), or in some cases to both. Thus in France the Na-tional Allowance for Dependency (APA) is paid to 605,000 means tested older people; however, in some cases family carers may also receive a salary.

In Germany the long-term care allowance is means tested and taxed and older people needing care can choose to take the cash (71 %) and organize care themselves, or take it in benefits in kind and use professional services (12 %), while 15 % combine benefits in kind and in cash.

In wealthy Luxembourg all those needing help are covered by de-pendency insurance, the amount varying by assessed levels of need. A dependent older person receiving a nursing allowance (23.85 euros per hour) can use up to 7 hours of care per week to pay a family or informal carer; if 7-14 hrs are needed, the service networks must provide half the hours, if more than 14 hours per week are needed they are entirely provided by help services. An-nually the dependent older person receives a double nursing al-lowance to finance respite care and give the family carer time for recreation.

In several countries the amounts actually paid are so low as to not even cover the direct costs of care, e.g. Malta, Hungary.

There are considerable debates on the benefits of paying family carers directly or the older person, with pros and cons for both arguments; paying the family carer directly may not allow flexibility and change in care arrangements and


40

also runs the risk of devolving all care responsibilities onto a single carer, whereas payments to the older person, although seemingly promoting more choice in care, may not be given to the family member providing the most care.

In many countries there is no public and statutory recognition of family carers (ES, PT, EL, PL, MT, BU) so that there is no entitlement to any kind of finan-cial payment, to leave from work or for respite care. In practice, even in these countries some reported that those family carers employed in the public sector did have some rights to paid and unpaid leave, though these rights were virtu-ally never exercised in the private sector (PT, SI). Typical of this situation was Portugal where public employees have the right to 15 days per year under the cover of ‘family medical certification’ to care for an older person, but in the pri-vate sector such leave is only available for the care of those under 10 years of age.

In other countries such as Austria and Germany, where increasing recognition is being given to the reconciliation of work and caring through such policies as care leave, reduced hours and the right to re-employment, there were com-ments that despite the rhetoric, family friendly policies are rare (1 % of compa-nies in Austria) and mainly for those with scarce skills. In Germany, new rights were introduced for working carers to have leave for short periods of up to one year, with or without wage adjustment, but only a few large Companies allow flexible hours or job sharing (AT, DE). In Sweden, the Care Leave Act (1989) ensures that those under 67 years and still in the labour force have the right to paid leave for 60 days to look after a dying family member.

A number of countries, even those without support services for family carers and very limited public recognition of their role, did permit tax relief and ex-emptions (FR, IE, EL, IT, NL, ES). In Ireland, tax relief was also available when a private carer was employed.

Another minimal financial form of support, mentioned as available to Maltese and UK family carers, was VAT relief on care aids.

In Ireland carers are eligible both for respite care benefits and for a Back-to-Education allowance when their caring responsibilities end.

2.5.4 Long-term financial Support

The long term consequences for family carers have been noted in many coun-tries. Some countries have moved towards supporting those providing recog-nised levels of care in order to both support family carers and ensure that in the longer term they do not land up worse off. In some countries, family carers could be officially recognised and employed as carers with a salary, employ-

Key Issues

41

ment benefits, pension and training (DK, FI, FR, IE limited, NO, UK). While these were the most extensive rights, other countries offered social insurance contributions to provide coverage for old age and accidents; pension credits are a recognised way of supporting family carers in a number countries (CZ, LU, NO, UK) while specific mention is made of coverage for accident and in-jury (AT, FI).

In Austria preferential insurance terms and pension contributions are given to non-employed family carers in the form of free non-contributory co-insurance with sickness benefits for those receiv-ing the long term care allowance for the more dependent (levels 4-7) with the state paying the employer’s contributions.

2.5.5 Formal Service Provision for older People (health, social services, residential)

Adequate and appropriate health and social services provided to older people, both in institutions and at home, are a major factor in supporting the work of family carers and relieving them of the total burden of care. In those countries with a broad spectrum of home care services (SE, DE, UK, NO, DK, FI, FR) that maintain and support older people in their own homes as long as possible, family members may have some choice in deciding whether and how much care they wish to undertake, although home help is often limited and does not exclude the need for help from the family. However the demographic projec-tions suggest that the degree of choice that older people and their family car-ers will have in the future may be dictated by public expenditure restrictions and private means.

In addition to services provided in the home (home-help, meals-on-wheels, personal care etc.), the provision of appropriate accommodation (permanent and temporary residential care, sheltered housing, home adaptations etc.) and transport services can significantly influence and extend an older person’s in-dependence and autonomy, despite increasing levels of disability, and this in turn helps family carers.

The Polish report describes how in some local areas, such as Poznan, initiatives have been undertaken to improve the quality of care and work conditions of family carers, largely as a result of pressure from well-organised self-help groups and NGOs of older people forcing local authorities to assign appropriate funds.

In Northern Italy, there is a current trend towards an increased involvement of market oriented care services, so that users (i.e. older people and their fami-


42

lies) “buy” care services from private suppliers that are paid for with public funds through vouchers and care allowances.

At the other end of the spectrum, Greece has no statutory social care services for older people though some home care programmes have developed over the past decades, initially by NGOs and more recently by local authorities; budget restrictions and inadequate funding means that coverage is limited and the services inevitably give priority to dependent older people without family support and with no financial resources to pay for private help.

2.5.6 Services for older People at Home

It is not always easy to distinguish between services primarily intended for the older person but which substantially reduce the problems and difficulties of the work of the family carers, and those services which are directly focused on and of benefit to the family carer. Thus respite care may directly benefit and even be designed for the family carer, yet essentially be a home based service for the older person. A huge range of services supporting older people exists, in-cluding general laundry services, special transport services, hairdresser at home, meals at home, chiropodist / podologist, telerescue / tele-alarm (con-nection with the central first-aid station or relative), telephone service offered by associations for older people (friend-phone, etc.), counselling and advice services for older people, care aids, home modifications, company for older people, social worker, handyman service, incontinence service. (See Annex 4 for the list of services developed from the national reports.)

Malta mentioned having 30 different services for older people, though with the interesting comment that many family carers using home help services felt it to be an admission of their inability to live up to family expectations, leading to an uneasy partnership between them and the formal service providers

For family carers the availability of good primary health care in the home is of great importance, as many older people are not well enough to move easily. Many countries (BE, DK, FR, DE, LU, MT, NL, NO, SE, CH and the UK) de-scribed their primary health care services as comprehensive, involving health care professionals in systematic outreach programmes, and included services such as palliative care at home (CH), and rehabilitation at home. The UK in-terestingly stated that the most popular primary health care services for older people were chiropody and the district nurse. In other countries (AT, BU, CZ, IT), primary health service into the home were considered partial with inade-quate regional coverage, while other countries described their primary health care services as inadequate (EL, ES, HU, PL, PT, SL).

Key Issues

43

The French primary health care system gives a legal right to its citizens to such services as hospital-at-home, a paramedical ser-vice and the delivery of drugs.

A strong trend noted in most countries was the growth in day care centres, whether attached to hospitals, run by local authorities or by NGOs. These cen-tres are of importance where the family carer works, but also for regular res-pite care particularly in the cases of older people with dementia. In some coun-tries (NO), coverage was relatively well-developed, apart from some of the ru-ral areas, while in other countries it was noted that coverage was very patchy (FR, IT, DE) with expansion being planned (IE, HU, EL) Only in Poland day care centres were actually decreasing in number. However, one should note the existing variations in the percentages using such centres. Belgium re-ported 0.3 % of those aged 65-70 years rising to 0.7 % for those 75 years and over. The Czech Republic, which had centres that offered day and weekend care, provided coverage for 0.6 % of those aged 65+. Malta had 5 % of it older citizens attending 14 centres, while in Spain coverage was for just 0.11 % of older people. Usage data was presented quite differently in the Netherlands – who reported 13 % of family carers using such centres, while in the UK 32 % of those receiving care went to such centres (day clubs, day care and day hospitals), a figure that went down to 27 % for those aged 85 and over. In Luxembourg, the 7 centres were designed for psycho-geriatric cases.

Home care services have been well established for many years in many countries and a wide range of services may be provided under this rubric in-cluding home help services (shopping, cleaning, cooking etc.) and personal care (bathing, cutting toe nails, toileting etc.) – however it was not always clear from the national reports what exact services were included in each category. The data provided shows the usage by the age of the older person - ranging from 1 % of those aged 65 years and over in Italy, to 15 % of those aged 60 and over in Denmark. Other figures demonstrate, not surprisingly, that the per-centages rise with increasing age. Denmark, Belgium and Finland commented that the average length of time for home help was just 2 hours per week, and many countries said that the demand was outstripping the supply both as a result of demographic changes but also, for example, with the introduction of long term care allowances which allowed dependent older people to have more access to such a service (AT). This indicates that many countries are facing the choices of how best to ration care to those who are most depend-ent. In the UK and Ireland, data indicated that those with family carers re-ceived less home care than those without a family carer.

In a number of countries including Finland, Sweden and the UK, it was com-mented on that home help was now given to less people but more intensively, e.g. in the UK 8.1 hours per week, while in Sweden 28 % received home help in the evenings and at night.


44

Belgium noted that the main beneficiaries were those who were very depend-ent and on a low income and no doubt similar criteria are used in other coun-tries, which may well account for the growth reported in a number of countries of private home help services; thus even in Denmark with its extensive ser-vices, people were paying for additional help. In some countries the costs of using the service meant that some could not afford it (BU).

Local coordination centres were important as a way of ensuring some coop-eration between health and social services. In Finland, personal care and ser-vice plans are made by multi-professional health and social service teams for persons in continuous need for care and there is an increased focus on the much older person. In Greece, many of the home care services under devel-opment are run in conjunction with the existing Open Care Centres for Older People (KAPIs) and provide both some health and social support. In Sweden, comprehensive local authority services provide transportation services, foot care, meals on wheels, security alarms, housing adaptations, handicap aids, etc.

Home help care programmes in Catalonia, Spain, are available in 90 % of the primary health care centres; more than 75 % of these offer carer training and almost 69 % specific “caring for the carer” programmes.

Given the particularly arduous nature of care for those with Alzheimer’s dis-ease or DAT related dependency, the development of special services to sup-port family carers is particularly critical. Norway reported that 80 % of all the local authorities provided sheltered units in nursing homes for persons with dementia in 2003, while Belgium, Luxemburg, Sweden and Finland also had good coverage. However, most countries reported that existing facilities are inadequate in terms of coverage and increasing demand (FR, IT, DE, IE).

One bright light for family care work was that many countries re-ported on the invaluable work done by different NGOs and espe-cially Alzheimer societies, e.g. in the UK they had 25,000 mem-bers and 300 centres running quality day and home care ser-vices, while in countries like Slovenia and Greece mention was made of the growing importance of the Alzheimer societies, par-ticularly when other forms of support for older people and family carers were less developed. Only Spain, Poland and Portugal gave no indication of such developments.

Key Issues

45

Even in Greece, where innovations are hard to implement and public financial support limited and erratic, the GARDA Associa-tion in Thessaloniki, supported by Alzheimer Europe, marks dy-namic and positive cooperation between health professionals and family carers with effective work in information, advocacy, counselling and service provision in an ever larger number of towns.

Quality Assurance

One way of ensuring that family carers feel that home care services can be safely used and relied on is that adequate quality assurance standards are in place. In many countries, the evaluation and monitoring of the standards of the service provided, whether by health or social care personnel in separate or integrated services, was felt to be inadequate. Many countries also reported that administrative criteria were the main criteria used to judge service ade-quacy, e.g. legal contract obligations, financial management, staff / client ra-tios, complaints, while even where local authorities had developed explicit cri-teria for service providers, these very rarely included the quality of the service from the perspective of the family carer or older person (AT, CZ, IE, DE, EL, PL, ES). What were the constituents of a good quality service assurance? These included national recommendations, the use of independent evaluation and monitoring, clear mission statements, the development of individual client plans drawn up with the older person or family carer, the development of qual-ity awards, and many countries felt they had adequate mechanisms in place (BE, DK, FI, FR, HU, LU, MT, NL, NO, CH, UK, SE). France noted that there were now special computer programmes designed for quality control for both home and residential care services.

In well developed systems it might well be expected that services would de-vote resources to ensure the level of training and competence of their staff. If European countries are moving to an increase in the number and coverage of both public and private care services in the home, then family carers and older people have to feel confidence in the abilities, commitment and concern of those providing services to the older person. 12 countries considered their staff adequately trained (AT, BE, BU, DK, LU, MT, IT, FI, DE, SE, NL, HU). However, there were differences between the qualifications of those run-ning services, who in most countries were trained and with professional certi-fication, e.g. as medical professionals, social workers etc, and those who pro-vide some kinds of hands-on care and support in the home. Austria, Italy and the Czech Republic commented on this issue. The difficulties in recruiting and keeping staff, especially at these levels, have already been discussed in the section on the work of caring (2.4.5). What was often missing was training for home help and geriatric aides. In Spain, the national report sadly pointed to the current inadequacies even amongst those of a professional background, since they often had inadequate profiles for the work, especially in supervision


46

and management; there was also scarce interest by other workers in jobs con-cerning the hygiene and personal care of the older person and in general a poor connection between the workers and the users of the services. This comment may well have resonance for a number of countries, e.g. FR, SI, CH.

2.5.7 Services for Family Carers

The most common form of service available for family carers was some form of respite care, predominantly in residential units with rather fewer offering such care in the older person’s or family carer’s own home. Respite care ser-vices at home probably constitute the most direct and immediate type of relief for family carers, whether this be in the form of ‘granny’ sitting for a few hours, or for a more extensive period such as a weekend, or to cover a holiday and allow the family carer to relax. Respite care was the only service for family carers reported by all the NABARES countries, although there was a very wide variety both in type of provision and coverage. Such services are well de-veloped in a number of countries (BE, NL, NO, SE, UK, DK, FR), whereas in others any form of provision is rare in EL, IT, PL, ES, PT, SI and with more ex-tensive, but still limited coverage in IE, DE, CH, MT. As with many other forms of support for family carers, private arrangements for relief care either at home or in a residential facility, were reported by many countries, either as a substi-tute for inadequate public services, or in parallel with them.

In Belgium 10,000 hours of sitting services were provided, a half by volunteers.

In the Netherlands more than 180,000 hours of voluntary pallia-tive home care were provided at home (more than 5200 volun-teers in palliative care). In contrast to formal carers these volun-teers do have a lot of time for the family carers.

Given the bureaucratic nature of many of the public systems by which family carers can access services or claim financial support either for themselves or for the older person directly, a major problem for many is how to fill in the right forms. Thus counselling and advice services that helped with such things as filling out forms were surprisingly prevalent amongst many of the 23 countries and 8 reported this as available throughout their country.

In Austria a provider of in-home hospice services (Caritas) offers a support programme for carers after the death of the older per-son.

Practical training in caring was available widely, where family carers learned to protect their own physical and mental health, relaxation etc. (IE, SE, MT,

Key Issues

47

NL, FI, FR, AT, BE, and the UK). A number of these were run by carer’s groups or NGOs. Many of these services overlapped with self help groups, de-signed to allow family carers to learn from one another how to deal with prob-lems and the emotional and practical aspects of caring.

Needs assessment by a service provider, providing a formal and standard-ised assessment of the caring situation, was a well developed service with to-tal coverage in DE, DK, FI, HU, BE, NL, SE, CH, UK, LU, partial availability in BU, CZ, DE, ES, IE, MT, NO, PL. but not available in AT, CH, EL, FR, IT, PT, SI, although the extent to which family carers were involved in these assess-ments was not always clear.

However, integrated planning of care for older people and their families, which should be a logical next step from needs assessment, was available in fewer countries, with total availability reported only in SE, UK, FI, HU and LU.

Whilst a number of countries reported special services for family carers of different ethnic groups, this was a statutory service only in the UK and even here was still not fully developed.

Other support services for family carers were reported by NL, HU and LU.

In Hungary, the vital role of NGOs such as the Hungarian-Maltese Charity service and the Hungarian Red Cross in providing nu-merous services for older people and their families was noted. Free food, clothing, medicine, medical and technical aids were provided where needed, using both state and other sources of funding and a large amount of volunteer work.

In the Netherlands, the important contribution made by the 200 Support Centres for Family Carers (information and advice, prac-tical and emotional support, training, mutual support groups, and voluntary home care and buddy care) was noted, as well as the wide variety of support services provided by LOT, the Dutch or-ganization for informal caregivers.

2.6 Residential and Long-Term Care

In this section, long-term care usually refers to institutional care provided and funded by the health sector, whilst residential care is usually provided by the social services sector with partial or full costs born by the user. However, it was not always clear from the NABARES reports which were being referred to and thus there may be some overlap between the uses of the two terms. From the point of view of the family carer and the older person needing care, how-ever, whether this type of care is provided free or for payment is obviously a major factor in decisions regarding the use of the service and may partly ex-


48

plain differences in patterns of use of institutional care facilities between coun-tries.

While it would appear slightly contrary to discuss residential care and family care simultaneously, the availability and quality of different forms of residential care for dependent older people helps determine the role of family carers and the types of support they can find. There are different developments in the 23 countries that depend in great part on historic levels of provision; those with low levels are often seeing a growth in new residential units to deal with demographic changes, while those who already have high levels are diversify-ing the forms of residential coverage available. Increasing longevity accompa-nied by age-related disability (even taking into account some decline in rates of severe disability) means that a higher number of older people will require care for longer periods of time; this, combined with the predicted decline in numbers and availability of younger generation family carers, means that inevi-tably an increasing proportion of older people will require the intensive care services only available in an institutional setting. This is already becoming ap-parent with many countries reporting a high proportion of more disabled older people and those without families in residential care.

An increasingly wide range of institutional care arrangements are reported, with a general trend in those countries with more developed services to move away from traditional residential care and rest homes, nursing homes and short and long term hospital care and convalescent homes, towards other forms of living units such as sheltered housing, specialised rehabilitation facili-ties, hospice and palliative care facilities and special dementia units and spe-cial facilities such as respite care (AT, BE / Flemish, NL). This has led to a less rigid classification of types of institutional care, with merging of the boundaries between health and social care and between home and residential care, i.e. towards more integrated care.

There is a wide mix of public, private and non-profit provision, with most public and NGO facilities, except hospital beds, being run by or in co-operation with local authorities. The highest level of residential care was reported in the Neth-erlands with 5 % of those aged 65 years and over in residential care homes and 2.5 % in nursing homes, and Luxembourg with 6.8 % of those aged 65 years and over. The lowest rate was reported in Greece with an estimated 1.5 %. Overall, as many countries indicated there is an increase in both the age and level of dependency of older people, as well as the proportion of de-mentia sufferers, in all types of residential care and there are often waiting lists, especially for specialist and modern units, e.g. Belgium has long waiting lists for dementia patients. However, in interesting contrast, Finland reports a decline in need for institutional care due to improved functional capacity of those 65 and over. In Italy, a decline by half in the percentage of over 85 year

Key Issues

49

olds in residential care has been attributed primarily to the employment of for-eign home care workers.15

There are significant cultural differences in the preferences of older people themselves for this type of care, though the time at which they were asked about their preferences as well as the wider socio-economic conditions in which they find themselves, also influences their responses. The critical issue is what they prefer when they can no longer care for themselves: nine out of ten Norwegian older people preferred a residential setting, while the Swiss also preferred professional care. Similar tendencies can be found in the Czech Republic, Poland, Slovenia and Hungary, where older people in need for care are put on waiting lists for admission and expanding long-term care and resi-dential facilities.16

While many countries reported a policy trend away from institutional care to-wards home care, some countries with high levels of mainly publicly funded residential care provision (AT, DK, SE) have not changed bed provision but have expanded other forms of residential care, e.g. sheltered housing in Nor-way, with a consequent decline in bed shortages in nursing homes. In Den-mark, the decline in nursing home beds has been matched by an increase in independent specialised housing units for older people with accompanying home care services, whereas Sweden covers all types of residential care un-der the umbrella heading “special housing”, entry being by criteria of need only, with a very high public service coverage and a wide variety of accommo-dation, balanced by improved and integrated home services provision. Finland has service housing with 24 hr assistance costing two thirds less than tradi-tional residential care and three quarters less than hospital care. In Spain, where residential care covers 3.4 % of over 65 year olds, the national report suggests an increase in public sector residential care. Malta and Germany noted increases in the demand for all types of residential accommodation, and in Germany residents consist increasingly of the older age groups and demen-tia sufferers. Even in Greece, despite the use of migrant workers and the start of some home care services, there has been a small increase in use of resi-dential care services (mostly private) from < 1 % to 1-2 % of > 65 year olds. A similar situation occurs, to a varying extent, in Italy, although there is a higher proportion of older people in residential care in the north than the south. Lux-embourg, with a currently high level of residential care provision, is expanding provision further and the report notes that the cost for such care per hour (35.82 euro) is actually cheaper than home care (48 euro).

In France, as in other countries, there are significant problems with many ex-isting residential homes, some of which are based on the old ‘poor-houses’,

15

See http://www.esf.org/articles/201/Famsuparticle.pdf 16

It is not entirely clear if this is because of established traditions or because of the difficult economic

circumstances of both families and older people.


50

though the development of new forms of small support residential and modern units is making some forms of residential care far more attractive.

In France and the Walloon part of Belgium the Cantous are spe-cial small units for older people with dementia where they share daily life and cooking activities under supervision. The family is involved in decision making and social life.

The costs of residential care clearly play an important role for family carers and older people since in many countries the older person or their family con-tributes or completely pays for this service. In the Czech Republic, long-term care was free and a dependent person received their entire pension plus any dependency allowance. In Denmark, rent was payable for the accommodation only, while care services were free. Long term care allowances awarded in line with assessed levels of disability and need were mainly used in Austria and Germany to cover the costs of residential care. A large number of countries had some forms of mixed payment – Switzerland, Hungary, Malta, Poland, Norway, Finland, and the Netherlands used various forms of means tested and co-payment according to the older person’s pension, though ensuring that the older person was left with some disposable income. In France, Ireland and the UK, older people in residential care were often publicly funded, though assets had to be used to pay part or all of the costs. Thus the amount of public sub-sidy for residential care varied considerably amongst countries. In most cases the poorest and most dependent may get subsidised, as in Spain, though 58.8 % are financed entirely by the user. In Slovenia, 66 % is funded by older people and family carers. In both Greece and Portugal the percentage paid for by the older person is even higher and NGO and religious charities mainly ac-commodate the isolated and those on a very low income. In Italy, only 5 % of residential accommodation is free.

In Luxembourg residents pay the full cost of care, while in Sweden they pay the costs of rent, meals and care with a cap on the costs for care; in both cases high incomes and pensions and state subsidies for those in need mean that the costs are not a barrier to usage.

The funding of long term care in some countries may actually favour institu-tional care, e.g. in Italy and the UK, long-term health care facilities may be free or partially covered as opposed to payment for social care facilities, which is means tested or completely privately paid by older people or family carers; in Belgium / Flanders family care at home may be more expensive than residen-tial care; for family carers in the Czech Republic, residential care may allow them to benefit from the older person’s pension, even if this involves moving the older person every 3 months to different facilities to avoid paying costs.

Overall many countries noted the decreasing length of public hospital stay for older people with increasingly earlier discharge after acute admissions, e.g.

Key Issues

51

Hungary. This puts increasing strain on both family carers and on home care services which have to provide higher levels of home care, e.g. UK.

While national and local governments may wish to limit public expenditure and older people and family carers prefer home or sheltered housing with home help services, as indicated care for dependent older people may cost a lot if they are kept in their original homes. There is no consensus of the optimum method of funding residential services and in many countries the choices available in different types of care facilities are very limited.

2.6.1 Sheltered Housing Units

Sheltered housing units are currently not available in a number of countries (BU, EL, HU, PL). Portugal noted the conversion of many of the older residen-tial homes into sheltered units, while Slovenia noted that though they have started there, there was reluctance amongst older people to sell the property and move into these relatively expensive dwellings. Both sheltered and other forms of residential accommodation offering support services are growing in most countries though they tend to be limited to those who are mentally dis-abled in Luxemburg, while in Norway older people with dementia may be ac-commodated in sheltered units in nursing homes. In the UK, figures showed 3.5 % of those aged 65+ in such housing, a figure that rises to 19 % for those aged 85 years and over. Again this availability of choice for the older person and family carer is important since the older person retains a home and inde-pendence though with appropriate 24 hour available support.

2.6.2 Hospices and palliative Care

Hospices and palliative care may be important for family carers, offering a specialist service to those needing terminal care and allowing both the older person and the family carers to get good psychological and physical care. They are not available in a number of countries including BU, EL and ES. In many countries such forms of service developed under the auspices of NGOs; thus the Czech Republic has 6 new units with 170 beds. In total, 11 countries mentioned the existence of hospices and palliative care, within residential units and in the community. Focussing on hospices and palliative care, the impor-tance of enabling family carers to continue care also in the terminal phase and to avoid institutionalisation must not be disregarded. Specifically, aspects like dignity and cost need to be reflected.

2.6.3 Residential Respite Care

As suggested in the earlier section (2.5.7), many countries de facto offer res-pite care, whether in specially designed units or as ad hoc arrangements.


52

In Bulgaria the widespread summer camps are sometimes used for the care of the dependent older person while the family carers take a holiday break.

2.6.4 Training and Quality Control and Family Carer Involvement

As discussed under home care services, the issue of training of care staff and quality control of residential care services is critical, particularly in those coun-tries with low usage. As with home care services, some countries employed a majority of skilled trained staff with the tendency for the less skilled categories of professional carer to be the ones with the least training or continuous edu-cation. The Czech report indicates the importance of this issue since the de-pendency levels in their institutions is worsening.

Again there is a tendency in many countries for administrative criteria to be used to asses quality standards, e.g. they focus on health and safety, staff- resident ratios, space and facilities. However ISO standards have begun to be introduced and were mainly regulated by local authorities (UK has twice yearly inspections, one unannounced and reports are published – the Care Stan-dards Act now sets national standards). FI implements repeat questionnaires for client feedback on quality i.e. availability, adequacy and functionality of ser-vices.

The involvement of family carers in residential care services appears to be in-creasing in Malta and the Netherlands and in Norway cooperation between staff and family caregivers is encouraged. This is partly due to changes from traditional forms of residential care to a wider variety of services, many of which involve family carers (respite care, shared care, etc.) and partly due to changing attitudes to and perceptions of care for older people. In Poland, Italy and Greece, family carers are often encouraged or even obliged to supple-ment and supervise residential care services that are inadequate due to lack of or indifferent, non-trained staff. Increasing budget cuts for residential care means that family carers and volunteers are increasingly needed to provide all forms of care (NL).

Additionally, family carers are increasingly concerned with the quality of care and feel themselves “partners in care” with formal service providers.

2.7 Current Policy Trends and Debates

Given the very different economic and welfare situations in each of the 23 countries, the discussions and the sophistication of social policy debates being held at local or national level vary enormously. This was particularly the case with respect to family care. Each national expert was asked to report on the state of debate on family care in their country and, though their comments may not be comprehensive they indicate what trends are occurring in each country.

Key Issues

53

As should be clear, in a number of countries a discussion or policy debate on the issue of family care does still not take place. While in most of these coun-tries (PL, EL, SI, MT, BU) this is the outcome of there being an assumption of the ‘normalcy’ of family care and / or laissez faire public welfare policy towards citizens, in the case of Denmark the lack of discussion is for the opposite rea-son, namely the policy of total state care for all dependent older persons. Other countries reported some growing consciousness of the likely increase in demand for support from the public sector as a result of the increasing num-bers of older people and the difficulties faced by family carers (BE, CZ, IT, FR, HU, CH). Unless family carers and older people are within a very well devel-oped welfare state, it appears that those with increased incomes turn to private solutions. Many public authorities essentially limit themselves to reactions to crisis rather than being proactive in the support of family carers. However, whether the state has primary responsibility for the care of older people or whether families or the individuals themselves bear the weight of care, there is some convergence in awareness of the need for shared care (public and fam-ily), whatever the starting point.

Not surprising given the demographic developments, public debate in many countries is concerned with how the public sector would be able to cover the costs of long term care of older people (FR, IE, BE, EL, NL, NO, SE, AT, LU, DK). The central debate revolves around who should pay - whether this should be funded through new taxation and new forms of social insurance and whether these should be public or private and born primarily by the older per-son and / or his / her family. The Austrian, German and Dutch evaluation un-derway of the effects and costs of the long term care insurance scheme will help countries like Spain and France who are considering setting up LTCI.

Providing adequate financial incentives to increase the numbers of individuals willing to provide family care is a debate in Switzerland (whether payments are made directly to the family carer or indirectly through the older person) and the current very low levels of reimbursement in a number of countries such as Austria is clearly no incentive. However, as referred to in the next section, any system of payment for family care will require adequate, continuous and objec-tive needs assessment of the older person if family carers are to be paid from the public purse.

As suggested in an earlier section, enforcing the provision of hands on care by the children of older people appears to be, in practice, unworkable; even mak-ing children take financial responsibility for dependent parents is difficult to im-plement, as illustrated by the current policy debate in Ireland, despite the fact that the country still has larger families to draw on for the financial support of their older members, as well as growing wealth. Italy was involved in a policy debate about whether payments to family carers were preferable to payments to the older person; both these systems were found amongst the 23 countries and it was evident that each had some drawbacks.


54

Much larger social issues are the central point of policy debates in many coun-tries. Thus the Lisbon agreement to increase labour force participation rates, especially those of women, throughout the member states of the EU has clear repercussions for the practical day to day support of older dependent people and indeed all types of home care. Will women in the future be willing to un-dertake both paid and unpaid care to the same degree, particularly in those countries that currently mainly rely on family care? In countries where family care issues are high on the agenda, defending carers’ rights to equality is a major policy debate; this has been particularly successful in Ireland where dis-crimination legislation also covers family carers as workers.

In Portugal the rapid social changes that are occurring are leading to a debate on individualism, life style changes and what they mean in terms of family care. The wealth of Norway has allowed them to provide both good services for older people without devaluing the place of family carers, by clarifying the roles of service providers and family carers in the provision of home care for the very dependent. As the Austrian report makes clear, those with better edu-cation and with better jobs are less willing to provide hands-on-care, a trend that will most likely be repeated throughout Europe. However, the OASIS study suggests that, given adequate services, family carers may be better able to provide more emotional, recreational and psychological support, thus, main-taining and improving the personal relationship between family carer and older person.

Malta and the Czech Republic were involved in policy debates concerning how they could change social attitudes towards ageing and promote greater inde-pendence amongst older people, which would also aid family carers. Nonethe-less, however much there is a chronological postponement of ageing, ulti-mately the fear of death and dependency at the end of life give a negative aura and set of attitudes. As the UK mentioned there is still the problem of the frail, ill and dependent older people and how to make positive social values out of this stage of the life course. The specialist role of residential facilities and hos-pices who may best be able to promote a positive image and experience about the end of life, “a good death” for older people and their family carers, was not mentioned directly in the reports, though the growth of hospices and their wide public support suggests that they may have started to play such a role.

The issue of family care has different advocates in some of the 23 countries. The strength of the family care associations and related NGOs in Ireland and the UK as well as in Finland and in the Netherlands is reflected in the fact that they are major stakeholders in the debates about the support of family carers, while in Italy it is the pensioners organizations who have taken on this policy issue with the regional and central governments.

A number of countries pointed to the fact that the main policy debates con-cerned the provision of more services even though, as in Luxembourg they were already relatively well off. There the main focus of the debate was on the

Key Issues

55

need for more rehabilitation services, palliative and hospice care and more trained workers. In others (CZ, ES, HU), the pressing need for more home care services for older people was the main focus, including more respite care services at home (NL). With regard to the latter, countries with the same policy concern could benefit from an evaluation of systems implementing respite care at home using voluntary or semi-paid substitute carers. Finland, with already good services in place, was involved in policy debates about introducing more flexibility in care to cover different levels of disability. A number of countries reported policy debates on how best to improve the status of family care work and ensure cooperation between family carers and the professionals in the provision of health and social services. This included the debate on whether and how to make family carers municipal workers (BE, FI, NL, AT, IE) as part of the team of care workers, thus blurring the traditional divisions between formal and informal care provision and the private and public spheres of life. Inevitably this had repercussions in the conclusion that more training would be needed for family carers (NL, DE).

Assuring good quality control for services for older people and family carers was a major issue in several countries (IT, EL, NO, DK). The development and implementation of ISO standards for both residential and particularly home care services where supervision is more difficult, would appear to be an impor-tant area for cross country co-operation within the EU, through both research and the open method of co-ordination.

The issue of need for legal guardianship for frail older people was reported by Italy and Luxembourg and, taking the issue further, Finland and the UK noted the need for judicial and advocacy support for both family carers and cared for older people. In response to this problem, Poland has developed good legal protection for older people against financial abuse, but it should also be noted that both family carers and older people would benefit from clear legislation in the form of contracts ensuring fair exchanges and payments in return for care, with due protection for the older person’s rights.

The detection, prevention and management of elder abuse was a policy de-bate in Austria and Belgium, and there are strong indications in the NABARES reports that this is of concern widely within Europe. It is also a major concern amongst policy makers in the USA.


56

3 Conclusions and Policy Implications

Despite the fact that many countries in Europe still do not acknowledge the role of family carers in the social and health support of older people, it should be evident from this report that politicians and policy makers at local, national and EU levels ignore the changing demographic structure of Europe at their peril!

The frequently mentioned ‘burden’ and spiralling costs for the care of depend-ent older people can only be confronted by utilising all available resources in a partnership approach to care. The four sectors of the welfare diamond (public, voluntary, family and private) concerned with the provision of care for older dependent people need to find a new balance in ways of working together, based on clearly agreed areas of responsibility. The policy in the EU to en-courage the labour market participation of women, including older women, will further reduce the already diminishing pool of family carers able to devote adequate time to hands on care and many ad hoc forms of care currently util-ised to fill this gap may not be the best solutions. The public sector, already responsible in large part for the health care of its population, needs to take a proactive role in the allocation of responsibility and the development of support for family carers.

Policy implications and recommendations are derived from the NABARES re-ports and what the national experts initially considered to be critical in their country for the support of family carers. However, the countries mentioned in the footnotes for each issue are in no way exhaustive and many authors sub-sequently commented that only their need to be selective had limited the inclu-sion of many of the other topics listed below. These and other issues emerge as areas where action might effectively be taken at the EU or at national and local levels for the support of family carers. This section covers issues con-cerned with types of support for family carers, service organization and provi-sion and, critically, the way in which family care can be an integral and ac-knowledged element in the care for dependent older people within the wider context of labour market policies.

The authors hope that the ideas discussed in this report, and the policy impli-cations summarised below, will stimulate thinking on how best each country can innovate and find solutions for the support of family carers.

3.1 More Services for Family Carers and older People

� Encourage innovation in providing new services for family carers and older people17

17

BE, UK, EL, AT

Conclusions and Policy Implications

57

� More short term and flexible respite care18

� More medium and longer term respite care centres19

� More day care20

Respite care is a key service in those countries where family carers undertake a lot of practical care. Consideration should be given to ways of covering long and irregular working hours for working carers including 24 hour and week-end care.

The trend in more advanced countries to have a variety of forms of flexible and attractive residential care to suit the various needs of both dependent older people and their family carers is one that needs to be systematically devel-oped in more countries.

� More palliative care21

� Palliative care22

The emergence of palliative care as a specialty both as a home and residential service, can alleviate the problems and concerns of both older people and their family carers and contribute to optimum care at the end of life. The role of humanitarian and religious organisations in this area of care should be ex-panded.

The promotion of local or regional Centres of Excellence which include training for family carers and professionals in palliative and end of life care.

Collaborative work with humanitarian and religious organizations at EU level.

� More formal, publicly supported home care services, e.g. home nursing, home help23

� More provision of specialised services at home, e.g. dental care, diagnostic services, rehabilitation, chiropody24

� Structures (financial, administrative) to support those with long term health care needs (ambulatory, residential and psychiatric)25

The wide disparities in the provision and coverage of home care services for older people in the 23 countries of the NABARES reports, underlines the ine-qualities currently experienced by family carers.

18

AT, DE, IT, IE, EL, NL, SI 19

AT, DE, EL 20

FR, PL 21

AT, DE 22

HU, PT 23

HU, PT, NO, FI, CZ, EL, PL, SI 24

PT, EL, SI, NO, FI, CZ 25

PT, CZ, EL


58

Within the EU the open method of co-ordination could stimulate member states to consider how to make the coverage of home care services more ex-tensive as well as methods of funding such services.

The extension of specialist services into the home requires the development of new technologies and lightweight equipment; the recognition of the market demand for such services may stimulate the private sector. The experiences of countries such as Finland with well developed public home health care ser-vices would be valuable.

Professional concern with the issue of long term health care at home is cur-rently at the centre of much discussion both at national and international levels (Groves and Wagner 2005, WHO 2005, WHO 2003)

The cost benefits of all forms of prevention and rehabilitation would be a good area for EU research and development.

� Meeting needs of those with dementia including more special residential care units and disseminating knowledge about dementia26

The important work of the Alzheimer Associations and groups throughout Europe was noted in most reports in the promotion of carers’ interests. This is an example of positive cooperation and an excellent multiplier effect when pro-fessionals and family carers work together.

� The effective development of services in rural areas27

Most countries in Europe have rural areas with high proportions of older peo-ple and difficulties in extending services into these areas at a reasonable cost. Hungary has managed under difficult economic circumstances to develop net-works of support using neighbours, friends and volunteers.

Cooperative research on the most effective and economic forms of support for OP in rural areas

� More home renovations and adjustments28

Using local resources and local staff to implement home modifications that aid family carers and dependent older people is a valuable and economically fea-sible service that could be provided by all local authorities.

3.2 Financial Support

� Financial support for family carers regardless of other financial support, e.g. widow’s pension29

26

AT, DE, BE, EL, IE, FR 27

NO 28

FI 29

FI, CZ, EL, SI


59

The short and long term benefits and their implications for the public purse of providing different forms of financial support for carers was not clear from the NABARES reports.

The short and long term benefits of varying forms of financial support to family carers is an important issue where exchanges of experience at EU level may be contribute to evidence based policy making.

Ensuring that family carers are adequately covered by social insurance (acci-dents, health, pensions etc) during the time spent caring should be a minimum EU standard contributing to the reduction of long term poverty amongst those who undertake family care.

Linking obligatory training to payments for care, as in Finland, helps to ensure both quality in care provision and adequate incomes for family carers.

� Encourage business sponsorship and other donors to fund support services30

The issue of how to fund services is critical for the majority of countries and mixed solutions need to be experimented with.

The exchange of information amongst EU countries on innovative and mixed forms of funding of services should be encouraged.

� Tax allowances and benefits for family carers 31

These exist in many countries, though often in lieu of any other form of sup-port.

National governments can use tax declarations as a way of estimating the numbers of householders claiming to look after dependent older relatives.

� Develop Long Term Care Insurance32

The central issue is that of funding and the willingness of governments and citizens to bear the generally increased costs through indirect or direct taxa-tion. The Austrian, Dutch, German and also the Japanese experience will be valuable.

3.3 Working Carers

� Promoting flexible workplace practices for family carers33

Development of part-time work in line with needs of both the employer and employee.

30

BU 31

FI 32

FR 33

AT, DE, IT, FI, UK, SI


60

The development of comprehensive labour market policies to include “caring as a lifetime resource” within the context of reconciling work and family life, e.g. part time work for both men and women with full pension and insurance credits for specified periods of time devoted to the care of children, dependent adults and older dependent people.

3.4 NGOs, Advocacy, Information, legal Advice, Counselling

� More information for family carers and older people34

This issue also emerged as important for family carers in the national surveys undertaken in the 6 core countries. All four sectors concerned with family care have an important, if different, role to play in the provision of information. Link-ing with successful disease-specific groups (Alzheimer, Parkinson’s, diabetes, etc.), as well as NGOs and advocacy groups to develop common interests and issues promotes effective collaboration and outcomes.

The proposed EUROCARERS NGO may consider making web and other links to existing NGOs and disease specific groups to promote general knowledge and common policy issues, e.g. service standards, effective support for family carers.

The vulnerability of many older dependent people and also family carers to exploitation and abuse needs to be addressed through adequate public legis-lation that several countries have already put in place.

Examination of legal issues relating to family care at EU level, e.g. guardian-ship, financial abuse.

� Not to shift financial costs of care to family carers 35

The promotion of the EU Carers’ Charter of Rights aims to protect family car-ers.

� Support formation of carers’ groups 36

The founding of a EUROCARERS group may help to give the issue a Euro-pean wide profile, but changing mind sets is not easy.

� Promotion of family care as work 37

One debate is whether policy development for family carers of older people should be included with that of family carers of dependent people of all ages. Unified policies have the advantage of avoiding age discrimination in support for family carers of older people, though the younger disabled may feel that

34

BE, BU, FI, EL, PL 35

FR 36

MT, EL, SI 37

NL


61

public resources for their family carers may be ‘diluted’ by the increasing needs of older dependent people.

The current discussion at EU level for the adoption of compulsory social insur-ance for family carers providing assessed levels of care above, e.g. 18 hours per week, is a positive development.

� Targeted public relations to promote public recognition of family carers38 and support civil society (NGO) initiatives 39

National, local and EU support for family carers advocacy groups is a way of promoting partnership between the sectors involved in family care.

The continuing financial and political support of the EU for organizations such as those in the Social Platform (including AGE), as well as others of relevance, is critical for their survival.

3.5 Formal Labour Force

� Incentives to increase recruitment into nursing and care work with older people by raising the status and improving the conditions of employment 40

� Targeting men

The evidence from a number of countries suggests that poor recruitment and retention in care work can be successfully overcome, although this may be partly dependent on the national economic situation and the labour market. Improving the training and status of the work as well as conditions of employ-ment are key elements to success. The recruitment of men as care workers may aid in the improvement of the status and wages of care work.

Scholarships for those in residential and other caring work.

Well-funded chairs in gerontological nursing and geriatric medicine

The development of EU recognised training standards and programmes for care workers.

In conjunction with national training schemes advertising campaigns by na-tional governments to promote a better image of care work. Such a campaign may also choose to target men as care workers.

� Optimize the recruitment of migrant care workers at all levels and regulate the private care services 41

38

DE, IT 39

HU, PT, IE 40

BE, DE, BU 41

DE, IT, EL


62

The significant role of migrant care workers suggests the need for more meas-ures not only to regulate and legalise their status but also to ensure their train-ing. The current unregulated use of migrants as private care workers in many countries is a temporary solution for the privileged middle classes as a re-sponse to a lack of public policy and services.

Encouragement of more EU training programmes to support migrant care ser-vice enterprises and migrant care workers training.

� Innovative practices and new technologies including the legal basis to help with assistive technologies and IT 42

The EU is already experimenting with IT and assistive technologies for older people and family carers.

Continued and increasing EU investment in research and dissemination of technologies that can aid care work and the organization of services.

3.6 Needs Assessment

� Systematic carer assessments43

� Care work involves a wide range of tasks in addition to support for household tasks and personal care, e.g. dealing with officials, financial support, gardening, accompanying.44

It is important to include all these areas in the needs assessment although this assumes the development of at least some appropriate support services for family carers or older people. A clear agreement on responsibilities between professionals and family carers for the various caring tasks is needed at the service level (see also section 2.5.7 on integrated care).

National and EU standardised comprehensive needs assessment procedures should be developed for older people, which include assessment of the role and needs of the family carer45. We need feedback on the effectiveness of ex-isting systems.

3.7 Promotion of Health and Well-being for Family Carers

� Gender-sensitive health promotion and prevention for family carers46

42

IE 43

UK 44

HU, DE 45

The COPE Index, CAMI, CASI and CADI are all validated carer assessment instruments.

http://www.shef.ac.uk/sisa/index.html 46

DE, IE, UK


63

The promotion of well being amongst family carers also contributes to an im-proved well being of the older people they care for. Although the national gov-ernments and the EU have worked on health promotion with respect to older people, less has been done for family carers.

Public authorities and policy makers should work closely with the media (e.g. public television and radio stations) to develop programmes aimed at family carers at home (skills training, counselling advice, chat shows, information)

� Provide more counselling for family carers47

Feedback is needed on the effectiveness and cost benefit of counselling in preventing carer depression and break down and in the promotion of carer’s well being.

� Programmes to support autonomy of OP48

An important issue in many countries where older people traditionally expect to receive family care and may not appreciate their own role in maintaining their physical and mental independence and well being.

Local authorities could contribute through a variety of programmes promoting active social participation of older people and their family carers.

3.8 Evaluation and Monitoring

� Involve family carers and older people in monitoring services improving evaluation49

Develop EU project on methods of effective, efficient and easily implemented evaluation for service providers and family carers.

ISO standards for all types of care services at EU level need to be imple-mented and encouraged in all European countries as a way of promoting qual-ity evaluation. This is an important area for cross country cooperation in the development of standards

� Supporting the national registration of family carers50

The difficulties of defining family carers are general and though a national reg-ister would help there has to be a real incentive to register.

47

UK 48

PT 49

UK, DK, SE 50

MT


64

3.9 Integrated Care and Training

3.9.1 Professionals

� Better co-ordination between different providers (usually health and social services), including any necessary legal provisions for cooperation between them51

Incentives for the provision of integrated care are being widely discussed by policy makers and professionals, e.g. the CARMEN Network http://www.ehma.org/projects/carmen.asp

� Better links between home and institutional care – integrated care (cooperation between multi-professional teams and family carers as team members).52

Integrated training needs to include decision makers and managers, as well as care workers and trainees.

� More training in the care of older people as well as training in team work for general medical practitioners53

Integrated care involves training in working as a member of a team that in-cludes family carers where relevant, and promotes links between sectors and improving geriatric knowledge.

Abolishing barriers to joint working between health and social services for older people is critical to the promotion of flexible and person centred care.

Higher education and continuous professional training institutes need to incor-porate training in integrated care for all professional team members (health and social service personnel and other support staff).

3.9.2 Family Carers

� More training for family carers and care support services54

� More training for family carers in multidisciplinary teams55

The “caring professions”, e.g. doctors and nurses, learn how to provide good professional care services without too much emotional involvement. Family carers, especially those providing a lot of hands on care, can be taught to “pro-fessionalize” some caring tasks allowing them to be more effective and effi-cient and to protect their own health. As well as organised training pro-

51

AT, BE, BU, HU, IE, PT, NO, PL, ES, FI, CZ, SI and DE (with respect to discharge.) 52

AT, BE, BU, DE, UK, CZ, EL, NL, ES, PL, SI 53

BE, BU, DE 54

AT, DE, BU, PT, FI, UK, CZ, EL, FR, SI 55

FI, PL


65

grammes, outreach ‘on-the–job’ training for family carers in the home by pro-fessionals is a practical and necessary alternative.

Health authorities should set up mechanisms, e.g. case conferences, outreach programmes, for the active and informed inclusion of family carers in inte-grated teams.

Training programmes for family carers need to be more widely developed and routinely include home based training by professionals (learning by doing).

3.9.3 Volunteers

� More training for volunteers56

� Further development of training concepts for volunteers working with family carers and older people57

The importance of volunteer work with family carers of older people is highly variable between the 23 countries. They may be particularly important in sub-stituting for family carers in the lighter forms of home care services, e.g. shop-ping, cooking, errands, as well as granny sitting and short term respite. Given the noted tendency for home care services to concentrate more on the most dependent section of the elderly population this form of volunteer support may have increasing value for family carers in the future. Consideration needs to be given to methods of increasing and ‘professionalizing’ some volunteer work so that it becomes a reliable service as well as informal arrangements. The partial payment of trained volunteer groups may provide particular social value to their work and help in the development of more extensive volunteer services in some countries. The role of organised volunteer work in supporting family car-ers has been under-researched particularly regarding the relative importance of different forms of volunteer service.

Local authorities responsible for the development and provision of services for older people should consider partial funding for organised, trained volunteer groups.

EU research is needed on evaluating the experiences of countries with volun-tary or semi-paid volunteer services, and trained vs. non trained volunteers, e.g. in the provision of respite care at home.

56

DE 57

DE


66

4 References

All the national reports (NABARES) contain their own bibliographies: http://www.uke.uni-hamburg.de/extern/eurofamcare/presentations.html

National Background Reports listed by Country:

Josef Hörl (2004) National Background Report for Austria

Anja Declerq, Chantal Van Audenhove (2004) National Background Report for Belgium

Lilia Dimova, Martin Dimov (2004) National Background Report for Bulgaria

Iva Holmerová (2004) National Background Report for Czech Republic

George W. Leeson (2004) National Background Report for Denmark

Terttu Parkatti, Päivi Eskola (2004) National Background Report for Finland

Hannelore Jani (2004) National Background Report for France

Martha Meyer (2004) National Background Report for Germany

Liz Mestheneos, Judy Triantafillou, Sofia Kontouka (2004) National Back-ground Report for Greece

Zsuzsa Széman (2004) National Background Report for Hungary

Mary McMahon, Brigid Barron (2004) National Background Report for Ireland

Francesca Polverini, Andrea Principi, Cristian Balducci, Maria Gabriella Mel-chiorre, Sabrina Quattrini, Marie Victoria Gianelli, Giovanni Lamura (2004) Na-tional Background Report for Italy

Dieter Ferring, Germain Weber (2005) National Background Report for Lux-embourg

Joseph Troisi (2004) National Background Report for Malta

Reidun Ingebretsen, John Eriksen (2004) National Background Report for Norway

Piotr Bledowski, Wojciech Pedich (2004) National Background Report for Po-land

Liliana Sousa, Daniela Figueiredo (2004) National Background Report for Por-tugal

Simona Hvalic Touzery (2004) National Background Report for Slovenia

Arantza Larizgoita (2004) National Background Report for Spain

Lennarth Johansson (2004) National Background Report for Sweden

References

67

Astrid Stückelberger, Philippe Wanner (2005) National Background Report for Switzerland

Geraldine Visser-Jansen, Kees Knipscheer (2004) National Background Re-port for The Netherlands

Mike Nolan (2004) National Background Report for the United Kingdom

Other References

Albert J and Kohler U (2004) Health care in an Enlarged Europe. European Foundation for the Improvement of Living and working Conditions, Dublin.

Groves T, Wagner E (2005) Editorial: “High quality care for people with chronic diseases” BMJ 2005; 330:609-610

Giddens A (1991) Modernity and Self-Identity: Self and Society in the Late Modern Age, Cambridge, Polity Press

Johansson SL (2004) NABARE Sweden

Magnusson L (2005) “Designing a responsive service for family carers of frail, older people using information and communication technology.” Dissertation for Goteborgs universitet, Goteborg,

Pflüger K (2004) “Study into the impact of EU policies on Family Carers”. AGE older People’s Platform, Brussels.

Pijl M (1994) “When private care goes public: an analysis of concepts and principles concerning payments for care”. In Payments for Care: A Compara-tive Overview. European Centre Vienna, Avebury.

Robine J Romieu I (1998) “Health expectancies in the European Union: pro-gress achieved”. REVES Paper 319. INSERM, Montpelier, France.

Theobald H (2003) Social Exclusion and the Care of the Elderly. CARMA (Care for the Aged at Risk of Marginalisation), EU report. Berlin: WBZ Social Science Research Centre.

WHO (2005) Preparing a Health Care Workforce for the 21st Century: The Challenge of Chronic Conditions, WHO Geneva.

WHO (2003) Key Policy Issues in Long-Term Care http://whqlibdoc.who.int/publications/2003/9241562250.pdf

Related Studies and Programmes

CARMEN - the Care and Management of Services for Older People in Europe Network http://www.ehma.org/projects/carmen.asp


68

EUROCARERS: European Organisation on Informal Care

http://www.york.ac.uk/inst/spru/eurocarers.htm

European Foundation for the Improvement of Living and Working Conditions http://www.eurofound.eu.int/

European Observatory on the Social Situation, Demography and the Family http://europa.eu.int/comm/employment_social/eoss/index_en.html

FELICIE - Future Elderly Living Conditions in Europe http://www.felicie.org

IPROSEC - Improving Policy Responses and Outcomes to Socio-Economic Challenges: changing family structures, policy and practice http://www.iprosec.org.uk/xnat.html

OASIS - Old Age and Autonomy: The Role of Service Systems and Intergen-erational Family Solidarity http://oasis.haifa.ac.il/

PROCARE – Providing Integrated Health and Social Care for Older Persons: issues, problems and solutions http://www.euro.centre.org/procare/

SHARE - Survey of Health, Ageing and Retirement in Europe http://www.share-project.org/

SOCCARE – New Kinds of Families, New Kinds of Social Care

http://www.uta.fi/laitokset/sospol/soccare/

Annexes

69

5 Annexes

5.1 Annex 1

5.1.1 NABARES Country List and Abbreviations

1. Austria AT

2. Belgium BE

3. Bulgaria BU

4. Czech Republic CZ

5. Denmark DK

6. Finland FI

7. France FR

8. Germany DE

9. Greece EL

10. Hungary HU

11. Ireland IE

12. Italy IT

13. Luxembourg LU

14. Malta MT

15. The Netherlands NL

16. Norway NO

17. Poland PL

18. Portugal PT

19. Slovenia SI

20. Spain ES

21. Sweden SE

22 Switzerland CH

23. United Kingdom UK


70

5.1.2 NABARES Analytic Matrices and Abbreviations in Matrices

< under

> over

Aut.Com. Autonomous Communities in Spain

Cos Companies

FC family carer

Fed. Federal

HH home help

Hrs hours

HS Health Services

LA Local Authorities includes municipalities

LTC Long term care

LTCI Long term care insurance

Ltd limited

NGO non governmental organization

NI National Insurance

OP older person

OW older women

p.a. per annum

p.m. per month

p.w. per week

PHC Primary Health Care

Rehab rehabilitation

SS Social Services

Annexes

71

5.2 Annex 2 – Future Research Needs

Hardly surprising given that the national experts were researchers, when asked to make recommendations on what research was needed, they had a long list of suggestions. The lack of common definitions and standards for gaining data means that national reports are not always easily useable at EU level. Greece, Poland, Portugal and the Czech Republic stated they would be happy to see any national research undertaken on the subject of family care and support services since so little research had been done. Specific sugges-tions are listed below.

� Longitudinal studies / cohort investigations at a national level. (AU, FR, DK, IT) including the needs and expectations of future cohorts of older people (BE)

� Families as long standing exchange systems; motivation of spouses and descendants to care, not to care and to stop caring (FR, AT, HU)

� organisation and economy of service provision, in particular the balance between public and private provision; issues related to financing, the bal-ance between services, and future planning of services (BG, FIN, NO)

� Empirical studies of elder abuse (AT, FI, FR, DK,UK)

� Action research e.g. aimed at supporting practice, via stepped-care and shared-care methodologies. (AT, BE, UK)

� Paid private care at home, migrant carers and their role as illegal and legal domestic care workers (IT, DK, DE)

� Gender specific aspects of family care (DE, FI, FR, MT)

� Carers in employment, conflicts between care and work, and a comparison with non working carers (FR, SE, UK, MT)

� Young carers (SE, UK)

� Family care and coping in everyday life, positive aspects of caring, strate-gies to cope with the burden (IE, FR, UK)

� Normative attitudes in society towards caring responsibilities- changing values in relation to income and education and increased female labour market participation (IE, FR, MT)

� Factors determining differences in the awareness of public services and the impact on use (ES)

� Dependence insurance including the evaluation of dependency, degrees of coverage, types of insurance and financing, price and the criteria of deter-mining the right to coverage (ES)

� Caring for persons with rare diseases (SE)


72

� Caring and ethnic groups and emigrants (SE, FR, DK)

� Validating evaluation procedures to measure user satisfaction in collabora-tion between the formal care and service system and family care (SE)

� Innovate Case Management and the role of New Public Management in the organising of care of older people and the perspectives of older people and family caregivers.(DE, NO)

� Dementia and family care (DK)

� The use of technology to support family carers and older people and re-duce their isolation (UK, IE)

� Carers support in rural settings (SE, FR, NO)

� Outcome of carers support (SE, FR)

� Comparison of care given by co-resident versus non co-resident family carers. (MT)

� Examination of the responsibilities and needs of the ‘sandwich’ generation of carers (Carers with multiple care obligations (MT)

� Need for “objective” policy proposals based on cost / benefit to all parties

Annexes

73

5.3 Annex 3 – STEP for NABARES

The standardised Evaluation Protocol (STEP) for the Reports had the following sections

� Introduction – An Overview on Family Care – 2-3 pages

� Data for each country on:

1. Profile of family carers of older people

2. Care policies for family carers and the older person needing care.

3. Services for family carers

– Good practices

– Innovative practices in supporting carers.

4. Supporting family carers through health and social services for older people

4.1. Health and Social Care Services

4.1.1. Health services – primary, secondary and tertiary care

4.1.2. Social services – home care services and residential care

4.2. Quality of formal care services and its impact on family caregivers

4.3. Case management and integrated care (integration of health and social care services to organise care around the patient / client).

5. The Cost – Benefits of Caring – how much does care cost and who pays

6. Current trends and future perspectives in family caregiving in each coun-try

7. Appendix to the National Background Report

7.1 Socio-demographic data on older people – Profile of the older population – past trends and future perspectives

7.2 Examples of good or innovative practices in support services

8. References to the National Background Report

Finally, and most importantly, we asked the authors to write three overviews to be used for national and EU policy recommendations in the final phase of the project with Key Points aimed at:

� Representative organisations of family carers and older people

� Service providers

� Policy makers


74

5.4 Annex 4 – List of Social Services for Older People

The following services were identified in the reports:

� Permanent admission into residential care / old people’s home

� Temporary admission into residential care / old people’s home in order to relieve the family carer

� Protected accommodation / sheltered housing (house-hotel, apartments with common facilities, etc.)

� Laundry service

� Special transport services

� Hairdresser at home

� Meals at home

� Chiropodist / Podologist

� Telerescue / Tele-alarm (connection with the central first-aid station or rela-tive)

� Care aids

� Home modifications

� Company for the older person

� Social worker

� Day care (public or private) in community centre or residential home

� Night care (public or private) at home or in a residential home

� Private cohabitant assistant (“paid carer,” mainly migrant care workers, le-gal or illegal)

� Daily private home care for hygiene and personal care

� Social home care for help and cleaning services / ”Home help”

� Social home care for hygiene and personal care

� Telephone service offered by associations for older people (friend-phone, etc.)

� Counselling and advice services for older people

� Social recreational centre

� Other, specify

5.5

A

nn

ex 5

– M

atr

ix S

erv

ice

s f

or

Fam

ily C

are

rs f

or

23 C

ou

ntr

ies

Ava

ilab

ilit

y

Vo

lun

tary

Serv

ices f

or

fam

ily c

are

rs

No

t P

art

ially

To

tally

Sta

tuto

ry

Pu

blic, N

on

sta

tuto

ry

Pu

blic

fun

din

g

No

pu

blic

fun

din

g

Pri

vate

Needs a

ssessm

ent (f

orm

al

– s

tandard

ised a

ssessm

ent

of

the c

aring s

ituation)

AT

, C

H, E

L,

FR

, IT

, P

T,

SI

BU

, C

Z, D

E,

ES

, IE

, M

T,

NO

, P

L

BE

, C

H,

DE

, D

K, F

I,

HU

, LU

, N

L,

SE

, U

K

BU

, D

E, D

K,

FI, H

U, LU

, M

T, N

L, N

O,

PL, S

E,

UK

ES

, B

E,

IE,

PL

ES

, IE

H

U

Counselli

ng a

nd A

dvic

e

(e.g

. in

fill

ing in form

s for

help

E

L, P

T

BU

, C

Z, D

E,

ES

, F

I, F

R,

IE, IT

, M

T,

NO

, P

L, S

I

AT

, B

E, B

U,

CH

, D

K,

HU

, IT

, LU

,

NL, S

E, U

K

BE

, B

U,

CH

, C

Z, D

E, D

K,

HU

, LU

, M

T,

NO

, U

K

AT

, B

E, C

H,

CZ

, E

S, F

I,

FR

, IE

, IT

, LU

, M

T, P

L,

SE

AT

, C

Z,

DK

, E

S,

DE

, F

R, IE

, IT

, M

T, P

L,

SI, U

K,

AT

, B

U, F

R,

HU

, IE

, M

T,

SI

BU

, D

E, D

K,

FI, F

R, M

T,

PL, U

K

Self-h

elp

support

Gro

ups

BU

, C

H, LU

, M

T

BE

, C

Z, D

E,

DK

, E

L, E

S,

FI, F

R, H

U,

IE, IT

, N

O,

PL, P

T, S

I,

UK

AT

, N

L, S

E

UK

D

E, E

S, F

I,

IT, N

L, P

L,

SE

BE

, C

Z,

DE

, D

K,

ES

, F

I, F

R,

IE, IT

, N

L,

NO

, P

L, S

I,

UK

AT

, B

E, E

L,

FR

, H

U, IE

, IT

, N

L, N

O,

PL, P

T, S

I

AT

, D

E, D

K,

FI, F

R, P

T

“Gra

nny-s

itting”

CH

, M

T, S

I

AT

, B

E, C

Z,

DE

, D

K, F

I,

FR

, IE

, LU

, N

L, N

O, P

L,

PT

, S

E, U

K

BU

, E

L, IT

B

U, D

E, U

K

BE

, F

I, N

L

BE

, C

Z,

DE

, D

K, F

I,

IE, N

L, U

K

BE

, B

U, E

L,

FI, H

U, IE

, LU

, N

O, P

L,

SE

AT

, B

E, D

E,

EL, F

I, F

R,

IT, D

K, P

L,

PT

, U

K

Pra

ctical tr

ain

ing in c

aring,

pro

tecting their o

wn p

hysi-

cal and m

enta

l health, re

-

laxation e

tc.

BU

, D

K

AT

, B

E, C

H,

CZ

, E

L, E

S,

FI, F

R, H

U,

IE, IT

, M

T,

NL, N

O, P

L,

PT

, S

I, U

K

AT

, D

E, LU

, S

E

DE

, LU

, U

K

DE

, E

S, F

I,

IT, N

L, P

L,

SE

AT

, B

E,

CH

, E

L,

ES

, F

I, F

R,

IE, IT

, M

T,

NL, P

T, S

I,

UK

AT

, C

Z, F

R,

HU

, M

T,

NL, N

O, P

L,

PT

FR

, P

T

75

Ava

ilab

ilit

y

Vo

lun

tary

Serv

ices f

or

fam

ily c

are

rs

No

t P

art

ially

To

tally

Sta

tuto

ry

Pu

blic, N

on

sta

tuto

ry

Pu

blic

fun

din

g

No

pu

blic

fun

din

g

Pri

vate

Weekend b

reaks

AT

, B

U, C

Z,

DK

, E

L, M

T,

SI

CH

, D

E,

ES

, F

I, F

R,

IE, IT

, H

U,

NL, N

O, P

L,

PT

, S

E, S

I,

UK

BE

, LU

D

E, F

I, L

U,

SE

, U

K

BE

, E

S,

IT,

NL, P

T

BE

, C

H,

DE

, E

S, IE

,

NL, U

K

HU

, N

L

BE

, D

E, E

S,

FR

, IT

, N

L,

PL, P

T,

UK

Respite c

are

serv

ices

AT

, C

H, C

Z,

DE

, D

K, E

S,

FI, F

R, H

U,

IE, IT

, M

T,

NL, N

O, P

L,

PT

, S

I, U

K

BE

, B

U, LU

, S

E

BU

, D

E, D

K,

FI, IE

, LU

,

MT

, S

E, U

K

AT

, B

E, IT

, E

S, N

L, P

T,

SI

BE

, C

H,

CZ

, F

R, IE

,

NL

AT

, F

R,

HU

, IE

, M

T,

NL, P

T

BE

, C

Z, E

S,

FR

, H

U, IE

, IT

, N

L, P

L,

PT

, S

I

Moneta

ry tra

nsfe

rs

BE

, C

H,

MT

, P

L, P

T,

SI

AT

, D

K, E

S,

FI, F

R, IE

,

NL, N

O, P

T

BU

, D

E, IT

, LU

, S

E

BU

,CZ

, D

E,

DK

, F

I, IE

,

IT, LU

, N

L

AT

, E

S

IE

AT

F

R

Managem

ent of crises

CZ

, D

K, P

T

AT

, B

U, C

H,

EL, E

S,

FR

, IE

, IT

, M

T,

NO

, P

L, P

T,

SE

, U

K

BE

, F

I, H

U,

LU

BE

, D

E, F

I,

FR

, H

U, LU

,

UK

AT

, B

U, E

S,

FR

, IE

, IT

,

PL, S

E

CH

, D

E,

FR

, IE

, IT

,

UK

AT

, B

U, F

R,

HU

, IT

, P

L

CH

, F

R

Inte

gra

ted p

lannin

g o

f care

fo

r eld

erly a

nd fam

ilies (

in

hospital or

at hom

e)

BE

, E

L,

CH

, P

T, S

I

AT

, B

U, C

Z,

DK

, IE

, IT

, M

T, N

L,

NO

, P

L, U

K

FI, H

U, LU

, S

E

DE

, D

K, F

I,

HU

, LU

, M

T,

NL, S

E, U

K

AT

, B

U, F

I,

IE, IT

IE

, P

L

AT

, B

U,

HU

, P

L

Specia

l serv

ices for

fam

ily

care

rs o

f diffe

rent eth

nic

gro

ups

AT

, B

E, B

U,

CH

, C

Z,

DK

, E

L, IE

, IT

, M

T, P

L,

PT

, S

I

DE

, F

I, F

R,

LU

, N

L, N

O,

SE

, U

K

U

K

DE

, F

I, N

L,

SE

D

E, F

I, N

L,

UK

N

L

76

Ava

ilab

ilit

y

Vo

lun

tary

Serv

ices f

or

fam

ily c

are

rs

No

t P

art

ially

To

tally

Sta

tuto

ry

Pu

blic, N

on

sta

tuto

ry

Pu

blic

fun

din

g

No

pu

blic

fun

din

g

Pri

vate

Oth

er

Support

Centr

es for

FC

s

volu

nta

ry h

om

e c

are

and

buddy c

are

, H

U-

-Maltese

Charity

serv

ice

BU

, C

H, P

L

NL, IE

H

U

N

L

HU

, IE

, LU

, N

L

HU

77

5.6

A

nn

ex 6

– M

atr

ix o

f F

am

ily C

are

rs’

Leg

al

Po

sit

ion

an

d R

ec

og

nit

ion

by S

tate

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

Austr

ia

Spouses legally r

espon-

sib

le for

one a

noth

er.

In

som

e p

rovin

ces a

nd d

e-

fined lim

its O

P c

an d

e-

mand m

ain

tenance fro

m

descendants

. C

hildre

n

have to c

ontr

ibute

fin

an-

cia

lly in m

ost

pro

vin

ces

under

socia

l assis

tance

law

s f

or

costs

of com

mu-

nity s

erv

ices / r

esid

ential

care

. E

xclu

des V

ienna

where

fili

al oblig

ation

abolished.

Incohere

nt re

gula

tions in

diffe

rent pro

vin

ces, de-

gre

e o

f enfo

rcem

ent is

variable

. S

upre

me A

dm

in

Court

and o

ther

legal

bodie

s h

ave m

ade d

eci-

sio

ns o

n w

hen p

rovin

cia

l

bodie

s c

an d

em

and c

ost

contr

ibution fro

m f

am

ily.

Pre

fere

ntial in

sura

nce

term

s f

or

non-e

mplo

yed

pro

vid

ing L

TC

. S

elf-

insura

nce u

nder

health

and p

ensio

n insura

nce

schem

es; fr

ee n

on-

contr

ibuto

ry c

o-insura

nce

with s

ickness b

enefits

to

care

rs in r

eceip

t of LT

C

allow

ance levels

4-7

.

1998 F

C a

cknow

ledged

in L

TC

Act – g

et pensio

n

contr

ibutions, sta

te p

ays

em

plo

yer

contr

ibutions.

Work

ing c

are

rs –

cla

im

max 1

week p

.a. fo

r re

la-

tive in c

om

mon h

ouse-

hold

. P

ossib

ility

of gettin

g

reduced w

ork

ing H

rs b

ut

only

1%

Co.s

have fam

ily

frie

ndly

policie

s –

main

ly

for

hig

hly

qualif

ied. 2002

com

passio

nate

leave for

dyin

g –

6 m

onth

pro

tec-

tion fro

m d

ism

issal- u

n-

paid

.

Federa

l LT

C a

llow

ance

1993 –

sin

gle

case b

ene-

fit to

com

pensate

for

care

rela

ted a

dditio

nal ex-

penses –

7 d

iffe

rent le

v-

els

- c

onsum

er

directe

d.

Sta

tuto

ry e

ntitlem

ent. N

ot

means t

este

d.

Hig

h s

ocia

l expecta

tion o

f

filia

l and s

pouse c

are

. D

e

facto

most

care

fro

m

fam

ilies b

ut w

om

en w

ith

care

ers

less w

illin

g to

care

.

Attem

pts

to c

hange s

ocia

l

attitudes o

f em

plo

yers

by

the F

am

ily a

nd W

ork

Audit.

Little c

o-o

rdin

ation a

nd

co-o

pera

tion b

etw

een

fam

ily m

em

bers

and s

er-

vic

e p

rovid

ers

.

Belg

ium

(Note

diffe

r-

ences b

etw

een

Wallo

on a

nd

Fin

ancia

l re

sponsib

ilities

but not to

pro

vid

e c

are

–

may inclu

de e

ven g

rand-

childre

n f

or

costs

of

resi-

dential care

.

Public

Centr

e for

Socia

l

Welfare

can r

ecla

im c

osts

of re

sid

ential care

fro

m

fam

ily

Yes

LT

CI exis

ts in F

lem

ish

part

plu

s incentives to F

C

for

care

of th

ose a

ged

70+

. P

ays for

non m

edi-

cal costs

and s

om

e L

As

Incre

asin

g p

ublic a

c-

know

ledgm

ent of th

eir

role

. O

P p

erc

eiv

e f

am

ilies

as less w

illin

g to c

are

.

How

ever

FC

still

critical.

78

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

Fle

mis

h a

rea)

giv

e e

xtr

a c

om

pensation

to F

Cs. V

ariations b

e-

tween r

egio

ns. W

alloon

are

a L

TC

I does n

ot exis

t.

Bulg

aria

Yes

Socia

l serv

ices c

annot

easily c

ollect

costs

of

care

back fro

m r

ela

tives if

not w

ell o

ff.

No

No

Socia

l expecta

tion, but

with m

ass e

mig

ration a

nd

inadequate

serv

ices,

there

are

pro

ble

ms.

Czech R

epub-

lic

Rig

hts

and o

bligations o

f

FC

s n

ot le

gally d

efined.

OP

Rig

ht to

health c

are

/

no r

ight to

socia

l care

favours

institu

tionalis

ation

and d

iscrim

inate

s a

gain

st

FC

– a

lso s

yste

m o

f re

-

imburs

em

ent of G

P c

are

favours

hospital vs. hom

e

care

and G

Ps “

reje

ct”

dependent O

P a

nd their

fam

ily c

are

rs

Pensio

n c

redits f

or

rela

-

tive’s

care

Paid

care

r’s a

llow

ance to

care

for

sic

k f

am

ily m

em

-

ber

if u

nable

to w

ork

due

to c

aring d

uties –

(1st 9

days x

1 for

dia

gnosis

) –

com

ple

x s

yste

m b

ut used

in a

reas o

f hig

h u

nem

-

plo

ym

ent

1)

Am

biv

ale

nt attitudes to

FC

by O

P a

nd F

Cs d

ue

to c

onflic

ts o

ver

respon-

sib

ilities b

etw

een s

tate

and f

am

ily (

socia

list vs.

traditio

nal).

2)

FC

s a

ct as m

anagers

of care

arr

angem

ents

Denm

ark

N

o

No

legis

latively

stipula

ted

rights

are

the r

ight to

com

pensation f

or lo

st

earn

ings in c

ase o

f caring

for

a d

yin

g r

ela

tive, and

the r

ight to

em

plo

ym

ent

as a

care

r w

hen c

ert

ain

conditio

ns a

re m

et

No –

welfare

sta

te funds

all

pro

vis

ions.

No r

ole

; no e

xpecta

tion.

But in

cre

asin

g r

ole

and

recognitio

n o

f F

am

ilial

netw

ork

s

Fin

land

No fam

ily o

blig

ation. Le-

gal oblig

ation o

f sta

te v

ia

munic

ipalit

y to p

rovid

e

care

for

dependent O

P

No

Yes, cle

arly d

efined in

Socia

l W

elfare

Act. D

ays

off, re

hab a

nd r

ela

xation.

Variety

of

pro

jects

.

Yes, by m

unic

ipalit

y –

als

o Inju

ry Insura

nce!!

Taxable

. A

mount varies

Attendant C

are

rs A

llow

-

ance. M

in 2

29,2

9 €

Yes, fo

rmal and legal

recognitio

n o

f care

r

sta

tus a

s p

art

of

socia

l

and h

ealth s

erv

ices D

e-

sire b

y O

P a

nd s

tate

to

incre

ase this

Fra

nce

Yes, spouses b

ut under

LA

can d

educt costs

in-

Means teste

d b

enefits

for

Tax b

enefits

m

ora

l expecta

tion o

f F

C –

79

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

civ

il code c

hild

ren a

re

obliged to m

ain

tain

their

moth

er,

fath

er

and o

ther

ascendants

3

curr

ed in c

are

of

OP

fro

m

inherita

nce

those 6

0+

national allo

w-

ance o

f dependency

(AP

A)

to O

P.

If F

C takes s

ala

ry t

hen

there

are

pensio

n c

ontr

i-

butions p

aid

.

AP

A b

eneficia

ries =

605,0

00

by p

olic

ym

akers

, socie

ty

as w

ell a

s p

ote

ntial and

active f

am

ily c

are

rs

share

, based o

n

the c

oncept of m

ora

l obli-

gation d

ue to o

ne’s

spouse a

nd o

ne’s

old

pare

nts

.

Germ

any

Yes. F

ilial oblig

ation, but

means teste

d

Means teste

d

Yes –

pensio

n, (5

80,0

00

FC

s u

nder

LT

CI)

cours

es

in c

are

giv

ing. T

ax b

ene-

fits

. R

ights

to leave for

short

periods o

r fo

r up to

one y

ear

and c

an b

e

gra

nte

d w

ith o

r w

ithout

wage a

dju

stm

ent. N

ew

–

only

few

larg

e C

os a

llow

flexib

le h

ours

or

job s

har-

ing

LT

C A

llow

ance. T

axable

.

Am

ount varies.

Atten-

dance A

llow

ance o

f m

in

230 €

.

71%

of th

ose n

eedin

g

care

dra

w b

enefits

in

cash &

org

aniz

e c

are

them

selv

es;

12%

dra

w

benefits

in k

ind a

nd u

se

pro

fessio

nal serv

ices a

nd

15%

com

bin

e b

enefits

in

kin

d a

nd in c

ash

Socia

l assum

ption o

f F

C

and legis

lative s

upport

for

fam

ily e

thic

. C

lass d

iffe

r-

ences in c

are

– L

/ c

less

accepting o

f re

sid

ential

care

. D

ecre

ase in a

s-

sum

ption o

f caring for

pare

nts

or

part

ner.

LT

CI

does n

ot in

cre

ase s

ocia

l

solidarity

. D

esire b

y O

P

and s

tate

to incre

ase this

.

Gre

ece

Yes in C

onstitu

tion

Not enfo

rceable

in p

rac-

tice

No, m

inim

al (6

days)

care

leave for

child

ren a

nd

dependent O

P (

eff

ec-

tively

sta

te e

mplo

yees

only

)

No. T

ax r

elie

f if c

o-

resid

ent and d

ependent

Socia

l expecta

tion to c

are

without re

cognitio

n o

f ro

le

Hungary

W

as o

bligato

ry b

etw

een

spouses a

nd g

enera

tions.

Fam

ily A

ct 1952, 1986

LA

s h

ave c

are

and fin

an-

cia

l re

sponsib

ility

for

OP

– r

egio

nal variations

Ltd

, le

ss than 4

hrs

work

p.d

. can g

et nurs

ing fee

but

low

level. (

may n

ot

be

less than 6

0%

of

old

age

pensio

n)

Must pay p

en-

sio

n c

ontr

ibution fro

m

this

.

LA

pays. N

o fin

ancia

l

incentive to c

are

. Low

take u

p

Socia

l expecta

tion to c

are

exte

nds to w

ider

socie

ty.

But shift to

more

form

al

support

for

OP

+ n

ew

serv

ices.

OP

often m

istr

usts

oth

ers

inclu

din

g r

ela

tives. F

C

80

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

receiv

ing n

urs

ing c

are

fee

often s

uspic

ious o

f fo

rmal

serv

ices.

Irela

nd

None

No s

tate

responsib

ility

either

Iris

h H

ealth B

oard

s in-

clu

ded the m

eans o

f adult

childre

n in a

ssessin

g

eligib

ility

of O

P for finan-

cia

l support

for

the c

osts

of nurs

ing h

om

e c

are

–

now

judged c

ontr

ary

to

rele

vant sta

tuto

ry r

egula

-

tions.

Pensio

n c

redits o

nly

available

dependin

g o

n

receip

t of C

are

rs’ A

llow

-

ance. In

adequate

cover-

age o

f costs

, C

are

rs

Benefits

taxable

. M

ax.

139.7

€, p.w

. 209.6

for

2.

Elig

ible

for

retu

rn to E

du-

cation a

llow

ance w

hen

caring r

esponsib

ilities

end.

Respite g

rant.

Care

r’s C

hart

er

Tax b

ased p

rovis

ions f

or

care

rs. T

ax r

elie

f and

medic

al expenses.

Only

600 g

ot C

are

rs’

Benefit (if ta

kes tim

e o

ut

from

em

plo

ym

ent)

– n

ot

every

one is e

ligib

le.

Fin

ancia

l support

most

import

ant is

sue f

or

FC

s.

Care

rs A

llow

ance m

eans

teste

d –

129.1

4 €

p.w

.

Socia

l expecta

tion to c

are

with incre

asin

g r

ecogni-

tion o

f ro

le. C

hanges w

ith

the r

ise o

f th

e 2

incom

e

fam

ily a

nd r

isin

g e

m-

plo

ym

ent le

vels

.

No info

rm o

n m

inorities

and c

are

.

Italy

Y

es to the third d

egre

e; a

fam

ily m

em

ber

requirin

g

assis

tance, can a

sk f

or

‘alim

ony’ fr

om

the f

am

-

ily58,

who m

ay f

ulfil

this

obligation e

ither

by p

ay-

ing a

n a

mount of m

oney

each m

onth

or

by a

ccept-

ing a

nd s

upport

ing the

pers

on n

eedin

g a

ssis

-

tance in their o

wn h

ouses

(art

icle

s 4

33, 438, 443 o

f

Art

icle

570 o

f th

e P

enal

Code p

rovid

es f

or

the

offence o

f “v

iola

tion o

f th

e

obligations o

f fa

mily

as-

sis

tance”

for

those w

ho

negle

ct subsis

tence to

the r

ele

vant re

latives,

incapable

of w

ork

ing, etc

No c

ase law

quote

d b

ut

de facto

pre

ssure

on

rela

tives to p

ay for

ad-

mis

sio

n to r

esid

ential or

Som

e-

especia

lly in p

ub-

lic s

ecto

r, h

ave r

ight of

continuous o

r split unpaid

leave u

p to tw

o y

ears

,

this

period o

f le

ave is n

ot

calc

ula

ted e

ither

in the

length

of serv

ice o

r in

the

socia

l-in

sura

nce s

chem

e.

Few

in p

rivate

secto

r use

this

rig

ht.

Not nationally

. A

t LA

level

ltd. econom

ic c

ontr

ibu-

tions f

or

FC

caring f

or

dependent O

P a

t hom

e

as c

ash c

are

allo

wances

based o

n n

eed a

nd in-

com

e (

the S

tate

care

allow

ance is g

rante

d o

nly

on the b

asis

of

necessity,

bein

g n

on-m

eans-t

este

d).

Regio

nal variations e

.g.

specia

l vouchers

in L

om

-

Assum

ption o

f F

C b

ut

ideolo

gic

al syste

m o

n the

fam

ily is c

hangin

g. S

till

caring in t

he fam

ily is

consid

ere

d a

s the b

est

solu

tion P

rivate

ly p

aid

hom

e c

are

keeps o

n

gro

win

g d

ue to the w

eak-

enin

g o

f th

e c

are

oblig

a-

tions o

f fa

mili

es a

nd to a

public s

yste

m c

onfined to

pla

y a

resid

ual ro

le o

f

58

These p

ers

ons, id

entified b

y law

, are

in the o

rder:

spouse; le

gitim

ate

, le

gitim

ized, natu

ral or

adopte

d c

hild

ren, and, if they a

re lackin

g, to

the c

losest

descendants

; pare

nts

and, if they a

re m

issin

g, th

e c

losest ancesto

rs e

ven n

atu

ral, a

nd a

dopte

rs; sons a

nd d

aughte

rs-in-law

; fa

ther-

and m

oth

er-

in-law

; bro

thers

and s

iste

rs, G

erm

an o

r half w

ith the form

er

havin

g p

recedence o

ver

the latter.

81

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

the C

ivil

Code).

hospital and s

ocia

l care

.

bard

y. M

ilan.

328 / 2

000 a

fis

cal polic

y

intr

oduces tax c

onces-

sio

ns f

or

fam

ilies w

ith

specia

l care

burd

ens, to

overc

om

e the p

roble

m o

f

care

that is

tota

lly d

is-

burs

ed b

y p

ublic s

er-

vic

es, and to d

iscoura

ge

irre

gula

r fo

rms o

f care

work

+ o

ther

tax d

eductible

costs

.

funder

(i.e

. of financin

g

care

), s

uch that now

a-

days this

repre

sents

the

main

sourc

e for

obta

inin

g

care

serv

ices, once the

pro

vis

ion o

f fa

mily

care

is

no longer

possib

le. It is

larg

ely

an info

rmal m

ar-

ket, w

hic

h a

lso e

xis

ts

because it evades p

ublic

regula

tions, but is

more

or

less e

xplic

itly

sup-

port

ed b

y the s

tate

.

Luxem

bourg

N

o

No

Yes c

ontr

ibutions to p

en-

sio

n f

unds o

nly

.

H

igh institu

tional pro

vi-

sio

n. E

merg

ence o

f new

attitudes t

o s

upport

OP

at

hom

e. S

mall

countr

y a

nd

pro

xim

ity to fam

ily –

as-

sum

ed fam

ily s

upport

but

no d

eta

ils o

n a

ctu

al socia

l

attitudes t

o F

.care

. D

e-

velo

pm

ent of re

spite c

are

suggest in

cre

asin

g r

ec-

ognitio

n o

f F

Cs. A

nd their

need f

or

support

.

Malta

Yes-

non m

ain

tenance o

f

pare

nt deducte

d fro

m

futu

re inherita

nce

Very

rare

N

ot rights

but de facto

respite c

are

Care

rs p

ensio

n’- 7

0 €

+

weekly

– c

ohabitin

g, fo

r

very

dependent. M

eans

teste

d S

ocia

l A

ssis

tance

for fe

male

s c

aring.

Means teste

d.

VA

T r

elie

f on thin

gs u

sed

by c

are

rs.

Not fo

rmally

recogniz

ed

but fa

mily

has p

riority

in

socia

l polic

y a

nd s

upport

serv

ices.

Assum

ed it

was

fem

ale

duty

, new

valu

es,

men h

elp

fin

ancia

lly. 41%

of th

ose w

ith c

are

rs p

en-

sio

n a

re m

en. C

hanges in

82

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

wom

en’s

role

s, sm

all

fam

ilies r

ecogniz

ed a

s

meanin

g d

ifficultie

s for

FC

s.

Neth

erlands

NO

– G

ovt. a

nd p

ublic

assum

es it

No c

ase law

on the r

ights

and o

bligations o

f F

Cs.

Negotiation w

ith n

eeds

assessm

ent agency a

s to

what is

extr

a c

are

for

FC

.

Many -

Fin

ancin

g C

are

er

bre

ak (

sin

ce 1

998)

off

ers

the p

ossib

ility for

a p

alli

a-

tive c

are

leave.

Sin

ce

2002 b

roadened, but

com

pensation is low

and

e m

any r

ule

s a

nd c

ondi-

tions t

hat

do n

ot

stim

ula

te

people

to a

rrange this

kin

d o

f care

leave. M

inis

-

try s

upport

FC

S thru

’

needs a

ssessm

ent,

stim

ula

tion o

f volu

nta

ry

work

, crisis

care

, re

spite

care

, m

onitoring o

f th

e

effect of

info

rmal care

,

financia

l aspects

, com

bi-

nation o

f w

ork

and info

r-

mal care

, and r

ais

ing

more

attention f

or in

for-

mal care

am

ong p

rofe

s-

sio

nal care

giv

ers

.

Yes –

13%

of

FC

s w

ith

extr

a e

xpenses r

eceiv

e

financia

l com

pensation,

of w

hic

h 7

3%

fro

m the

care

receiv

er.

(P

ers

onal

Care

Budget)

Only

6%

from

socia

l security

, 6%

via

taxes, and 2

0%

men-

tioned a

n u

nknow

n

sourc

e. O

n a

vera

ge the

com

pensation w

as 2

85 €

in 2

001,

Incom

e t

ax m

easure

s

80%

assum

e F

C a

s a

matter

of cours

e –

though

OP

less. R

ecent changes

in h

ealth c

are

im

plic

ate

FC

s w

ho a

re e

xpecte

d to

pro

vid

e m

ore

care

for

their r

ela

tives.

Norw

ay

no legal oblig

ations o

f

caring b

etw

een a

dult

genera

tions

No

Pensio

n / c

redit r

ights

-

all

care

rs a

re g

iven p

en-

sio

n p

oin

ts -

3 a

year

(corr

espondin

g to a

wage

cle

arly b

elo

w a

vera

ge).

1,8

50 p

ers

ons r

eceiv

ed a

munic

ipal care

wage f

or

care

of O

P –

irr

espective

of in

com

e-

but difficult to

get, h

as t

o involv

e h

eavy

duties a

nd m

ost F

Cs

don’t a

pply

for

it. B

ut

30,1

32 p

ers

ons a

ged 6

5+

'Welfare

sta

te o

rienta

tion'

= e

xpecta

tions a

bout

rela

tive r

esponsib

ilities o

f

the w

elfare

sta

te a

nd the

fam

ily in the 3

dom

ain

s o

f

socia

l polic

ies a

nd s

er-

vic

es for

old

er

people

:

financia

l support

, in

str

u-

83

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

receiv

ed a

ssis

tance p

en-

sio

n fro

m the N

ational

socia

l security

board

in

2002 f

or

those n

eedin

g

care

due to long-t

erm

illness, in

jury

or

impair-

ment.

menta

l help

and p

ers

onal

care

. A

pers

on's

'pre

fer-

ences f

or

care

' are

a

com

pro

mis

e b

etw

een

norm

ative c

onsid

era

tions

and p

ers

onal pre

fere

nces

Pola

nd

Yes, financia

l oblig

ations

(allow

s f

or fa

mily

inte

r-

dependence)

–sta

te o

bli-

gations o

nly

to “

fam

ilies

with d

ifficult s

ocia

l and

mate

rial situation”

(de-

fined)

via

LA

s

Yes, als

o w

ith join

t le

gal

agre

em

ent on inherita

nce

in e

xchange for

care

.

Em

plo

yed F

Cs o

f dis

-

able

d (

all

ages)

have the

right to

2 / 5

2 leave (

not

self-e

mplo

yed)

Not to

care

r but “a

tten-

dance a

llow

ance”

for

ALL >

75s

Socia

l expecta

tion to c

are

without re

cognitio

n o

f ro

le

Port

ugal

Constitu

tional right after

1974 to s

ocia

l pro

tection

from

sta

te.

In C

ivil

Law

Code d

e-

scendants

obliged b

y law

to p

rovid

e for

their a

s-

cendants

– s

ocia

l security

policy o

pera

tes w

hen

they c

annot pro

vid

e s

uch

care

.

Civ

il rights

to p

rote

ct O

P

– r

ight to

suste

nance

under

str

ong p

rote

ction

(Art

. 2003)

for

suste

-

nance, housin

g, clo

thin

g,

Art

icle

2009 N

o.1

b a

lso.

Public

em

plo

yees r

ight to

15 d

ays p

er

year

under

the c

over

of

‘fam

ily m

edi-

cal cert

ific

ation’ to

care

for

OP

– b

ut in

private

secto

r only

available

for

care

of

those u

nder

10

years

.

No.

Fin

ancia

l help

only

to

dependent O

P w

ho m

ay

use it

to p

ay F

C

Recip

rocity in fam

ilies,

Socia

l expecta

tion to c

are

without re

cognitio

n o

f

role

,

Indirect sta

te s

upport

e.g

.

day c

are

centr

es, health

centr

es.

Socia

l pre

ssure

accom

-

panie

d b

y h

ostilit

y to-

ward

s institu

tions. S

ocia

l

change in a

ttitudes w

ith

oth

er

pre

ssure

s p

lus in-

cre

ased s

ocia

l pro

vis

ion.

Gra

dual develo

pm

ent of

part

ners

hip

betw

een f

or-

mal and info

rmal care

rs.

Slo

venia

Y

es

for adult c

hild

ren a

nd

step c

hild

ren if pare

nts

/

steppare

nts

cannot w

ork

Polic

y a

nd p

lannin

g to

support

dependent O

P

bein

g d

evelo

ped, in

clu

d-

7-1

4 d

ays / y

ear

paid

com

pensation f

or

nurs

ing

sic

k c

o-h

abitin

g c

lose

New

Act fo

r dis

able

d

(may inclu

de O

P)

to

choose a

“fa

mily

assis

-

1)

See a

s for

Czech

above. 2)

Als

o, pare

nts

substa

ntially

help

young

84

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

and d

o n

ot have s

uffic

ient

funds

for liv

ing. F

inancia

l

obligation to s

upport

e.g

.

costs

of

resid

ential care

,

but no legal oblig

ation to

care

, although “

unw

ritten

rule

” fo

r at le

ast te

mpo-

rary

FC

ing h

om

e h

ealth c

are

. fa

mily

mem

bers

. ta

nt”

(obligato

ry tra

inin

g)

with p

art

ial paym

ent fo

r

loss o

f w

ork

– a

pplie

s to

OP

in c

ert

ain

cases, w

ith

crite

ria b

ein

g d

efined.

Attendance a

llow

ance

paid

to p

ers

on (

inclu

din

g

dependent O

P)

needin

g

consta

nt care

.

fam

ilies –

OP

with p

rop-

ert

y w

ant to

leave it to

childre

n a

nd w

on’t s

ell,

but not alw

ays a

ccom

pa-

nie

d b

y r

ecip

rocity in c

are

by c

hild

ren. P

eople

be-

lieve t

he S

tate

will

take

care

of

every

thin

g.

“Socie

ty takes F

C for

gra

nte

d a

nd they d

o n

ot

exis

t as far

as p

olit

icia

ns

are

concern

ed.”

Spain

Y

es,

Spanis

h c

ivil

regula

-

tions a

ssig

n the r

espon-

sib

ility

for

attendin

g a

nd

caring for

the d

ependent

eld

er

on the s

pouse a

nd

childre

n (

Spanis

h C

ivil

Code.

Book I

). -

spouses

and a

ll ascendants

and

descendants

are

recip

ro-

cally

oblig

ed to g

ive

main

tenance p

roport

ion-

ate

to the m

eans o

f th

e

donor

and the n

eeds o

f

the r

eceiv

er.

Infr

ingem

ent to

fulfil

legal

duties o

f assis

tance w

ill

be p

unis

hed w

ith a

rrest

from

eig

ht to

tw

enty

weekends (

Spanis

h P

e-

nal C

ode)

.

FC

not re

cogniz

ed. ord

i-

nance. (L

aw

39 / 1

999,

Concili

ation o

f fa

mily

and

work

ing life)

conte

m-

pla

tes the r

ight to

a r

e-

duction in the w

ork

ing

day w

ith a

pro

port

ional

reduction o

f sala

ry, and /

or

leave for

a tim

e n

ot

exceedin

g o

ne y

ear

to

look a

fter

a r

ela

tive w

ho,

for

reasons o

f age, is

unable

to look a

fter

him

/

hers

elf.

40%

of F

C h

om

es g

et

under

600 €

p.m

. R

e-

gio

nal G

ovts

may g

ive

fam

ily s

ubsid

ies. e.g

.

Aut.C

om

Madrid g

ives

cash a

id to F

Cs if a

nnual

incom

e o

f th

e fam

ily is

under

9,2

86 €

and O

P

very

dis

able

d. T

he m

ax.

am

ount of aid

is 2

,710 €

p.a

.

Tax r

eductions -

by a

ge

and f

or

expenses a

ssoci-

ate

d w

ith the a

ssis

tance

of th

e e

lderly o

r dis

able

d

when the taxpayer

is o

ver

65

Expecte

d a

nd few

ser-

vic

es.

Attention t

o F

Cs is

very

recent.

Sw

eden

No s

tatu

tory

responsib

ility

for

childre

n to p

rovid

e

care

or

econom

ic s

upport

for

their f

am

ily m

em

bers

NO

Y

es, C

are

Leave A

ct

(1989)

pro

vid

es r

ight to

paid

leave for

those u

n-

der

67 y

ears

and in the

Yes, plu

s the inte

gra

tion

of care

r support

into

the

form

al care

managem

ent

syste

m A

ttendance a

l-

The r

e-d

iscovery

of F

C

follo

win

g d

ecades o

f ex-

pecta

tions that th

e s

tate

will pro

vid

e a

ll necessary

85

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

labour

forc

e for

up to 6

0

days to a

ttend to a

fam

ily

mem

ber

in a

term

inal

care

situation. C

overe

d

under

National S

ocia

l

Insura

nce a

t th

e s

am

e

level as s

ickness p

ay-

ment

low

ance: an u

nta

xed

cash p

aym

ent to

the d

e-

pendent, u

sed to p

ay the

fam

ily m

em

ber

for

her

help

. T

he m

onth

ly p

ay-

ment is

modest

(SE

K

5 0

00 / m

onth

(~ 5

50 €

).

serv

ices f

or

OP

– C

are

r

300 p

roje

ct

Sw

itzerland

Variations b

y C

anto

ns

O

P is f

unded a

nd m

akes

decis

ions. A

ssum

ption o

f

FC

with p

rincip

le o

f sub-

sid

iarity

, w

here

the fam

-

ily, th

e indiv

iduals

take

their o

wn r

esponsib

ility

in

term

s o

f care

. T

he s

tate

inte

rvenes o

nly

when the

fam

ily c

annot find a

ny

oth

er

altern

ative P

olic

ies

are

still

to the im

port

ance

of F

C a

nd h

ave n

ot re

ally

gra

sped the s

cope o

f th

e

issue, neither

in e

co-

nom

ic term

s,

neither

in

socie

tal te

rms.

UK

N

o

No

N.I. C

redit p

aid

for

every

week F

C g

ets

Invalid

Care

Allo

wance (

unle

ss

they e

lecte

d to p

ay the

low

er

'marr

ied w

om

an's

sta

mp' som

e y

ears

ago).

Or

Hom

e R

esponsib

ilities

Pro

tection for

every

com

-

ple

te y

ear

a F

C c

are

d for

Yes. S

evera

l w

holly o

r

part

ly m

eans teste

d in-

clu

des C

are

rs A

llow

ance,

Invalid

Care

Allo

wance.

FC

s m

ay c

laim

£ 4

3.1

5 a

week; C

are

r P

rem

ium

, an

additio

nal sum

of

up to

£ 2

5.8

0 a

week p

aid

as

part

of In

com

e S

upport

,

Indiv

idual decis

ions –

dependin

g o

n O

P a

nd

fam

ily r

ela

tions. N

o p

ublic

assum

ption o

f F

C though

wid

espre

ad.

86

Co

un

try

Leg

al O

blig

ati

on

L

eg

al E

nfo

rcem

en

t o

f

Du

ties o

f F

C

Rig

hts

of

FC

- p

en

sio

n,

leave

Fin

an

cia

l re

co

gn

itio

n

Ro

le o

f F

C a

nd

so

cia

l

att

itu

des

som

eone p

rovid

ed they

are

gettin

g A

ttendance

Allo

wance o

r D

isabili

ty

Liv

ing A

llow

ance c

are

com

ponent at th

e m

iddle

or

hig

her

rate

. T

his

pro

-

tects

the s

tate

pensio

n.

Vouchers

– issued b

y L

A

entitlin

g F

C to leave b

y

payin

g for

pro

f. C

are

.

incentives to h

elp

care

rs

get

back t

o w

ork

. S

om

e

form

er

FC

s a

re e

ntitled to

Housin

g B

enefit and

Council T

ax B

enefit

or

Rate

Rebate

for

4 w

ks

after

they g

o b

ack to

work

. E

mplo

yers

who

take o

n form

er

FC

s c

an

som

etim

es b

enefit fr

om

payin

g less N

.I. at firs

t.

Additio

nal P

ers

onal T

ax

allow

ance f

or

marr

ied

men w

ith d

ependant chil-

dre

n a

nd w

hose w

ives

are

severe

ly p

hysic

ally

or

menta

lly d

isable

d

thro

ughout th

e tax y

ear.

Incom

e B

ased J

ob S

eek-

ers

Allow

ance, H

ousin

g

Benefit and C

ouncil

Tax

Benefit. F

rom

Oct

2002

people

over

65 c

an m

ake

a c

laim

for

the c

are

rs’

allow

ance, but if h

ave

pensio

n the s

am

e o

r

hig

her

than the IC

A r

ate

will not get allo

wance b

ut

may b

e e

ntitled to the

Care

rs p

rem

ium

if

they

are

on a

low

incom

e.

Direct P

aym

ents

to F

Cs

from

Socia

l serv

ices c

an

only

be s

pent on g

ettin

g

the s

upport

the c

are

r has

been a

ssessed a

s n

eed-

ing.

87

5.7

A

nn

ex 7

– M

atr

ix R

esid

en

tial C

are

Serv

ices (

Insti

tuti

on

al

care

, in

clu

des

resid

en

tial

ho

mes,

nu

rs-

ing

ho

me

s,

sh

ort

an

d l

on

g t

erm

ca

re h

os

pit

als

)

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Au

str

ia

Resid

en

tial care

– N

o g

row

th 1

7%

of

all

wom

en a

ged 8

5+

use s

uch c

are

. 68,5

11

pla

ces in s

enio

r and n

urs

ing h

om

es a

ge

60 +

in 7

40 institu

tions; about 49,8

00

"nurs

ing”

beds in o

ld a

ge a

nd n

urs

ing

hom

es a

nd 1

8,0

04 p

laces in r

esid

ential

care

for

less f

rail

eld

erly; als

o o

ld-a

ge

hom

es, have s

om

e n

urs

ing b

eds, th

us

dis

tinction b

etw

een o

ld a

ge a

nd n

urs

ing

hom

es im

possib

le A

ppro

x. 40,0

00 w

om

en

and 1

1,0

00 m

en in O

P’s

hom

es o

r nurs

ing

hom

es; P

roport

ions o

f O

P u

nchanged

sin

ce the 1

960s a

nd n

o m

ajo

r gro

wth

in

institu

tional care

expecte

d.

Resp

ite –

gro

wth

Sh

elt

ere

d h

ou

sin

g -

gro

wth

Ho

sp

ital sta

y –

declin

e in

len

gth

of

sta

y

OP

60+

= 5

3%

; 75+

= 2

6%

of to

tal sta

ys

in h

ospitals

Reh

ab

ilit

ati

on

– h

om

e s

erv

ice

Ho

sp

ice –

pallia

tive c

are

– y

es,

new

develo

pm

ents

resid

ential and a

t hom

e.

Dem

en

tia –

move a

way f

rom

‘old

’ in

stitu

-

Yes -

LT

C A

llow

ance.

+ u

p to 8

0%

of pen-

sio

n u

sed to fin

ance

public r

esid

ential

care

.

Dependent pers

ons

(defined b

y the c

rite

-

ria f

or

long-t

erm

care

benefits

) have a

legal

right to

adm

issio

n to

public r

esid

ential care

regard

less o

f in

com

e.

Most re

sid

ents

are

beneficia

ries o

f lo

ng-

term

care

allo

w-

ances.5

9 P

aym

ent to

the a

gency b

earing

the c

osts

, usually the

pro

vin

cia

l auth

ority

.

The b

ala

nce is p

aid

as p

ocket m

oney.

Insura

nce F

unds

handle

75%

of

the

financin

g o

f care

39%

of nurs

ing h

om

e

NO

. C

are

r doesn’t

pay

Main

ly u

nm

arr

ied

and / o

r child

less O

P

in h

om

es. N

o tra

ditio

n

of coopera

tion b

e-

tween F

C a

nd s

taff

Lack o

f nation-w

ide

regula

tions a

nd s

tan-

dard

s. In

part

icula

r,

hom

e h

elp

ers

, geriat-

ric a

ides a

nd fam

ily

help

ers

are

tra

ined o

n

the b

asis

of re

gio

nal

regula

tions. A

dditio

n-

ally

, th

ere

exis

t cur-

ricula

develo

ped b

y

non-p

rofit pro

vid

ers

.

The p

rovin

cia

l au-

thorities a

re r

esponsi-

ble

for

the c

onstr

uc-

tion, up-k

eep a

nd

opera

tion o

f nurs

ing

hom

es a

nd to g

uara

n-

tee m

inim

um

sta

n-

dard

s

Ltd

to r

atio o

f clie

nts

/

care

rs +

com

pla

ints

NG

Os h

ave inte

rnal

contr

ols

This

is d

esired b

y O

P

and F

C

59

For

insta

nce, in

Low

er

Austr

ia m

ore

than h

alf o

f all

resid

ents

are

cla

ssifie

d in long-t

erm

care

level 4 o

r hig

her;

only

6 %

of

all

resid

ents

do n

ot re

ceiv

e

long-t

erm

care

allo

wances (

Löger,

Am

ann, 2001: 67).

88

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

tional care

expenditure

s a

re

covere

d b

y c

ontr

ibu-

tions.

Belg

ium

R

esid

en

tial care

– 1

,875 r

est hom

es for

84,1

93 p

eople

with lim

ited d

isabili

ties a

nd

896 n

urs

ing h

om

es for

28,6

70 p

eople

with

majo

r dis

abili

ties. M

any r

est hom

es a

nd

nurs

ing h

om

es h

ave w

aitin

g lis

ts, espe-

cia

lly those n

urs

ing h

om

es w

ith w

ard

s f

or

people

suff

ering fro

m d

em

entia.

Crite

ria for

adm

issio

n -

Multi-dis

cip

linary

evalu

ation r

eport

s a

nd s

tandard

ized

evalu

ation s

cale

s u

sed f

or

adm

issio

n-

str

ict crite

ria inclu

din

g n

eed f

or

help

with

AD

L, in

abili

ty to liv

e a

t hom

e.

Som

e

hom

es a

dm

it, oth

ers

exclu

de p

eople

with

dem

entia.

Majo

rity

are

private

not fo

r pro

fit.

Resp

ite c

are

within

122 c

entr

es in n

urs

-

ing h

om

es in the F

lem

ish R

egio

n. In

Wal-

loon R

egio

n, alm

ost no r

espite c

are

.

Sh

elt

ere

d h

ou

sin

g –

fo

r d

em

en

tia +

?

Ho

sp

ital sta

y g

eriatr

ic w

ard

beds d

e-

cre

ased R

ehabili

tation?

Ho

sp

ice –

pallia

tive c

are

Dem

en

tia –

yes s

pecia

l w

ard

s, plu

s inno-

vato

ry s

mall

units –

canto

us –

see F

rance. C

osts

av. M

onth

ly

€ 9

91.5

7. H

igher

than

wages a

nd d

iffe

rence

gro

win

g.

35%

rest

hom

es /

45%

nurs

ing h

om

es /

80%

HC

serv

ices a

nd

100%

hom

e n

urs

ing

financed b

y p

ublic –

tax a

nd s

ocia

l contr

i-

butions, F

ed. G

ovt

com

pensate

s f

or

de-

pendent 65+

takin

g

into

account and

household

liv

ing in a

poin

t scale

.

Fle

mis

h –

com

pensa-

tion for

non m

edic

al

costs

.

Som

e w

ill n

eed h

elp

from

rela

tives to fi-

nance their s

tay. M

ay

get

benefits

fro

m the

Public

Centr

e for

Socia

l W

ork

whic

h

can try

to g

et re

im-

burs

em

ent fr

om

the

childre

n o

f th

e p

ers

on

involv

ed.

– v

aries.

In F

landers

FC

at

hom

e m

ay b

e m

ore

expensiv

e to F

C than

resid

ential care

.

Difficultie

s in fin

din

g

cert

ifie

d n

urs

es. G

ovt.

am

eliora

ting w

ages

and w

ork

ing c

ondi-

tions.

Good q

ualit

y.

89

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Bulg

aria

135 long term

care

facili

ties c

overing 1

1

078 O

P.

Resid

en

tial care

– H

om

es for

eld

erly

people

accom

modate

those u

nable

to look

after

them

selv

es a

nd s

atisf

y their b

asic

needs; pers

ons w

ho a

re c

ert

ifie

d w

ith first

or

second d

egre

e o

f dis

abili

ty a

nd a

ctive

treatm

ent in

their c

ase h

as e

nded; per-

sons w

ho h

ave n

o r

ela

tives to take c

are

of

them

; pers

ons w

ho h

ave n

ot sig

ned a

contr

act fo

r cedin

g p

ropert

y a

gain

st obli-

gation for financia

l support

and / o

r care

.

Resp

ite

Sh

elt

ere

d h

ou

sin

g –

NO

Ho

sp

ital sta

y

Reh

ab

ilit

ati

on

Ho

sp

ice –

pallia

tive c

are

– N

O

Dem

en

tia

Paid

for fr

om

sta

te

and O

P p

ensio

n.

A c

ontr

act m

ay b

e

sig

ned f

or

cedin

g

pro

pert

y a

gain

st obli-

gation f

or financia

l

support

and / o

r care

.

No

Yes

?

Czech R

e-

public

74 4

99 b

eds in tota

l in

clu

din

g 5

4 2

61 b

eds

for

adults.

Resid

en

tial – L

ong w

aitin

g lis

ts, N

o long-

term

nurs

ing c

are

institu

tions. A

quite h

igh

pre

fere

nce a

mongst O

P for

resid

ential

care

. 67%

of 60 y

ears

consid

er

institu

tions

to b

e a

better

solu

tion a

nd a

better

guar-

ante

e o

f care

than liv

ing a

t hom

e o

r in

a

sheltere

d h

om

e w

ith h

om

e h

elp

. C

rite

ria

for

adm

issio

n to h

om

e o

r a b

oard

ing h

om

e

for

pensio

ners

are

: achie

vem

ent

of

the

retire

ment age a

nd s

ubm

issio

n o

f th

e

application for

pla

cem

ent,

Fre

e –

OP

continue to

receiv

e a

ll of pensio

n

+ a

ny d

ependence

allow

ance. E

ven for

long-t

erm

sta

ys o

f

more

than a

year,

covere

d b

y h

ealth

care

insura

nce.

Health insura

nce

com

panie

s t

ry to lim

it

the s

tay to 3

month

s

in their indiv

idual

contr

acts

with facili

-

Not financia

l – m

ay

even b

enefit fr

om

OP

pensio

n w

hen in r

esi-

dential health c

are

.

Can p

ay e

xtr

a for

better

facili

ties

FC

s t

ry to c

om

pen-

sate

for

poor

nutr

itio

n

and inadequate

nurs

-

ing.

FC

s u

sually s

upport

OP

in s

heltere

d u

nits.

Skill

ed n

urs

ing p

er-

sonnel consid

ere

d

unnecessary

in s

ocia

l

resid

ential in

stitu

tions

despite p

rovid

ing

serv

ices f

or

depend-

ent and s

ick o

lder

people

.

Directo

rs o

f re

sid

en-

tial hom

es d

o n

ot

need to m

eet any

qualif

ication c

rite

ria

Post

1989 N

GO

s

develo

ped m

any in-

novative types o

f care

and s

erv

ices a

nd

have fill

ed in m

any

gaps. R

esid

ential

hom

es o

rigin

ally

ow

ned b

y the s

tate

get re

gula

r fu

ndin

g

from

the s

tate

budget,

NG

Os h

ave to r

ais

e

their o

wn funds a

nd

they h

ave to a

pply

for

90

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Resp

ite –

Res. C

are

used for

tem

pora

ry-

respite c

are

, but lim

ited p

laces a

nd long

waitin

g lis

ts f

or

pla

cem

ent especia

lly in

Pra

gue a

nd o

ther

citie

s

Sh

elt

ere

d h

ou

sin

g in s

malle

r units in

com

munity

Hospital sta

y lim

it the d

ura

tion o

f a p

a-

tient’s s

tay in a

cute

depart

ments

and O

P

often n

ot w

elc

om

e.

Reh

ab

ilit

ati

on

– n

o

Ho

sp

ice –

pallia

tive c

are

– 6

hospic

es

with 1

71 b

eds r

un b

y N

GO

s, new

Dem

en

tia –

yes, new

ties b

ut fa

mili

es n

ot

able

or

will

ing to take

care

of

the O

P b

y-

pass this

3 m

onth

s

limit b

y m

ovin

g their

OP

fro

m o

ne facili

ty t

o

anoth

er

(and fro

m

one insura

nce c

om

-

pany to a

noth

er)

.

For

OP

in s

tandard

old

larg

e f

acili

ties,

they a

re o

ften r

em

ote

and F

C c

an’t g

et to

them

a g

rant fr

om

the s

tate

budget. G

rants

are

dis

trib

ute

d thro

ugh

the p

rocess o

f public

com

petition c

ontr

olle

d

by M

inis

try o

f Labour

and S

ocia

l A

ffairs

(and b

y M

inis

try o

f

Health).

Applic

ations

have to b

e s

ubm

itte

d

each y

ear

Denm

ark

Resid

en

tial – D

eclin

e in n

urs

ing h

om

e

beds f

rom

31,0

00 in 1

999 to 2

4,0

00 in

2003. 1987 e

nded c

onstr

uction o

f re

sid

en-

tial nurs

ing h

om

es a

nd e

ncoura

ged d

e-

velo

pm

ent of in

dependent specia

lised

housin

g f

or

OP

with c

are

serv

ices b

ein

g

pro

vid

ed in the h

om

e. “L

ost”

nurs

ing h

om

e

pla

ces r

epla

ced b

y independent housin

g

units for

old

er

people

– their n

um

ber

has

incre

ased f

rom

32,0

00 in 1

999 (

had b

een

18,0

00 in 1

994)

to a

lmost 43,0

00 in 2

003.

All

but 65 n

urs

ing h

om

e p

laces o

ut of

alm

ost 26,0

00 h

ave the h

ighest le

vel of

pro

vis

ion.

Resp

ite

Sh

elt

ere

d h

ou

sin

g –

Sheltere

d h

ousin

g

units h

as a

lso d

eclined– fro

m 4

640 in

1999to

3572 in 2

003.

Rent accom

modation. G

ood / Innovative

pra

ctice -

auth

orities

are

obliged to e

sta

b-

lish a

rela

tives’ coun-

cil

– the a

im is to

impro

ve d

ialo

gue a

nd

involv

em

ent

of

rela

-

tives o

f re

sid

ents

Yes

Yes A

ccounta

bili

ty

with r

egard

to the

quality

of care

is w

ith

LA

even w

hen r

ecip

i-

ents

of care

may

choose a

pro

vid

er

oth

er

than the p

ublic

pro

vid

er.

In a

dditio

n, a fra

me-

work

of

mechanis

ms,

whic

h a

llow

the r

e-

cip

ient (o

r re

latives)

to

com

pla

in a

nd a

ppeal,

is in p

lace.

91

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Un

its f

or

OP

incre

ased 8

8,0

00 in 1

999 to

91,0

00 in 2

003. 48,0

00 o

f th

is tota

l are

linked to e

xte

nsiv

e c

are

serv

ices.

Ho

sp

ital sta

y / R

eh

ab

ilit

ati

on

Ho

sp

ice –

pallia

tive c

are

Dem

en

tia –

In 2

002, th

ere

were

alm

ost

5000 p

laces d

esig

nate

d s

pecific

ally

for

pers

ons s

uff

ering fro

m d

em

entia –

incre

asin

g s

teadily

Fin

land

Resid

en

tial – In 2

001 3

.7%

of pers

ons

aged 6

5+

and 8

% a

ged 7

5+

were

liv

ing in

old

age h

om

es o

r housin

g w

ith 2

4 h

ours

assis

tance. 529 m

ill €

on inst care

. 89%

arr

anged b

y m

unic

ipalit

ies, 11%

by o

r-

ganiz

ations, and less than 1

% b

y s

mall

ente

rprises.

Resp

ite –

acute

, short

-term

or

inte

rval.

Care

in institu

tions

Sheltere

d h

ousin

g=

-Serv

ice h

ousin

g

Ho

sp

ital sta

y –

the n

um

ber

of clients

aged 6

5+

is d

ecre

asin

g in a

ll in

stitu

tional

care

in h

ealth c

are

.

Reh

ab

ilit

ati

on

- y

es

Ho

sp

ice –

pallia

tive c

are

- yes, som

e r

un

by p

rivate

foundations, m

ost in

health

centr

e h

ospitals

. – o

r at hom

e.

Dem

en

tia–-

in 1

995 (

late

st data

) fr

om

100

000 d

em

ente

d p

ers

ons 4

0 0

00 w

ere

in

long term

resid

ential care

.

Serv

ice h

ousin

g 2

4 h

r

assis

tance –

37 e

daily b

ed c

harg

e

Resid

ential hom

e –

96,9

e, In

patient pri-

mary

HC

– 1

35,9

e.

Need f

or

institu

tional

care

declin

ed b

e-

cause o

f in

cre

ase in

functional capacity o

f

65+

Depends o

n c

lient’s

financia

l sta

ndin

g a

nd

may n

ot exceed 8

0%

net in

com

e m

onth

ly.

(must have a

t le

ast 80

e for

ow

n e

xpenses)

Spouse s

ituation a

lso

taken into

account fo

r

LT

C

Good / Innovative

pra

ctice Y

es P

rofe

s-

sio

nal cert

ific

ation

defined b

y legis

lation

– o

nly

qualif

ied w

ork

-

ers

can g

et a job.

Hig

h level of

geriatr

ic

know

ledge a

mong

pro

fessio

nals

.

Min

istr

y o

f socia

l A

f-

fairs a

nd H

ealth g

ives

national re

com

men-

dations for

the d

ev.

and q

uality

of ser-

vic

es f

or

OP

– H

C,

serv

ice h

ousin

g a

nd

resid

ential care

. A

ct

as g

uid

elines for

Mu-

nic

ipalit

ies to e

valu

ate

the s

erv

ices they

offer.

Associa

tion o

f

Fin

. L a

nd R

eg A

uth

has a

lso tried to im

-

pro

ve Q

ualit

y o

f care

– b

ut each c

hooses

ow

n m

eth

ods.

Good / Innovative

pra

ctice -

Com

mon

repeat use o

f ques-

tionnaire o

n c

lient’s

opin

ions o

n a

vaila

bil-

ity, adequacy a

nd

92

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

functionalit

y o

f ser-

vic

es i.e

. user

feed-

back.

Fra

nce

Resid

en

tial – 4

71,0

00 p

ers

ons >

60

years

; m

ost

sta

te, som

e p

rivate

. 6.5

00

traditio

nal hom

es for

OP

(public, private

non p

rofit and c

om

merc

ial): av. no. of

pla

ces (

1996):

60 in p

rivate

non p

rofit

institu

tions, 75 in p

ublic

hom

es, 86 in p

ub-

lic h

om

es in p

ublic

hospitals

, 48 in p

rivate

com

merc

ial hom

es.

Popula

tion m

ain

ly f

em

ale

(w

idow

s,

62%

,

29%

sin

gle

s a

nd d

ivorc

ed).

Pop. old

due

to the a

v. age w

hen e

nte

ring: end o

f 1999,

79 y

ears

for

men, and 8

4 y

ears

for

wom

en.

Resp

ite. S

om

e institu

tions s

pecia

lize in

short

term

care

and v

ery

help

ful to

FC

s.

Sh

elt

ere

d h

ou

sin

g –

3.0

00 b

eds

Ho

sp

ital sta

y 1

,100 n

urs

ing h

om

es, gen-

era

lly d

ependin

g o

n a

public

hospital;

Reh

ab

ilit

ati

on

Ho

sp

ice -

pallia

tive c

are

Dem

en

tia 1

975, specia

l in

stitu

tion d

evel-

oped f

or

OP

suff

ering fro

m d

em

entia: th

e

“Canto

u”.

Tw

elv

e p

ers

ons a

re liv

ing to-

geth

er;

Costs

part

ly b

orn

by

resid

ents

and r

egio

nal

govern

ments

(C

on-

seils

généra

ux

Enorm

ous d

iffe

rences

from

one d

épart

em

ent

to the o

ther;

costs

: estim

ate

d a

t 3.9

bill

ion in 2

003 a

nd 4

bill

ion in 2

004.

The a

vera

ge m

onth

ly

rate

is 1

,300 €

(2004),

the a

vera

ge incom

e

of pensio

ners

1,4

40 /

month

for

men a

nd

894 /

month

for

wom

en

No –

institu

tions r

un

like h

ospitals

. F

C

limited to v

isitin

g –

often r

elu

cta

ntly.

Socia

l in

tegra

tion

extr

a m

uro

s is p

as-

siv

e. 70%

report

regu-

lar

fam

ily c

onta

ct and

vis

its f

rom

friends,

form

er

neig

hbours

and c

olleagues.

Am

ongst th

ose (

30%

)

who d

o n

ot have a

ny

conta

ct w

ith their

fam

ily tw

o in thre

e

decla

re that th

ey d

o

not have c

hild

ren o

r

that

all

fam

ily m

em

-

bers

are

dead

But in

CA

NT

OU

fam

-

ily m

em

bers

are

in-

vited to s

pend a

s

much tim

e a

s p

ossi-

ble

within

the g

roup,

part

icip

ating in a

nd

genera

ting a

ll sort

s o

f

indoor

and o

utd

oor

activitie

s.

Tra

inin

g a

vaila

ble

- but

no a

dvanta

ge in m

any

conte

xts

.

New

law

to u

p d

ate

and im

pro

ve the

30,0

00 m

edic

o-s

ocia

l

institu

tions for

old

and

dis

able

d p

ers

ons

(resid

ential and d

om

i-

cili

ary

serv

ices),

in-

clu

des the o

blig

ation

of qualit

y e

valu

ation.

But sin

ce the n

ew

govern

ment, “

Raff

arin

III”

, (M

arc

h 2

004),

this

inte

ntion s

eem

s to

have lost its p

riority

.

Very

negative im

ages

as o

ld h

ospic

es f

or

indig

ent / pro

ble

matic

and w

ere

huge. R

eal-

ity is b

etter

but im

age

sto

ps F

Cs w

anting to

use r

esid

ential

hom

es. 15%

of re

si-

dential in

sts

need

tota

l re

sto

ration, 30%

part

ly, i.e. 200,0

00

beds,

1 /

3 o

f to

tal;

93

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Germ

any

Resid

en

tial – G

row

th in n

os. +

suff

ering

from

dem

entia. In

1999 8

,659 L

TC

=

645,4

56 p

laces. >

half (

56,6

%)

financed

by independent charita

ble

org

anis

ations,

1 / 3

by p

rivate

com

merc

ial bodie

s

(34,9

%)

and the r

est public

(8,5

%).

28%

(554,0

00)

of people

in n

eed o

f care

are

in r

esid

ential care

. O

lder

genera

lly

than those c

are

d for

in d

om

estic s

ettin

g.

66%

in r

esid

ential care

are

80 y

ears

+ b

ut

only

44%

of care

d for in

dom

estic s

ettin

g

are

> 8

0

Resp

ite –

som

e a

vaila

ble

and p

aid

for

by

LT

CI but urb

an / r

ura

l diffe

rences.

Sh

elt

ere

d h

ou

sin

g –

many k

inds

Ho

sp

ital sta

y –

incre

ase in g

eriatr

ic in

patient fa

cili

ties t

hough long term

tre

nd is

to r

educe length

of

sta

y to r

educe c

osts

.

Reh

ab

ilit

ati

on

– y

es

Ho

sp

ice -

pallia

tive c

are

– y

es in a

ll

form

s

Dem

en

tia In 2

002, th

ere

were

alm

ost

5000 p

laces d

esig

nate

d f

or

pers

ons s

uf-

fering fro

m d

em

entia –

incre

asin

g s

teadily

LT

C insura

nce c

an b

e

used to p

ay tow

ard

s

care

costs

.

Care

allow

ances c

al-

cula

ted a

ccord

ing to

the c

are

cate

gories

whic

h p

ay f

or

medic

al

treatm

ent care

and

socia

l care

. O

ther

costs

paid

for

by the

pers

on in n

eed o

f

care

, w

ith p

ensio

n

and s

avin

gs o

r by

revert

ing to the r

e-

sourc

es o

f clo

se f

am

-

ily m

em

bers

. If O

P o

r

rela

tives h

ave n

o

resourc

es the s

ocia

l

welfare

pays in a

c-

cord

ance w

ith the

Federa

l Law

on W

el-

fare

Benefits

"support

in d

ifficult life-

situations".

In 1

998

36%

of all

resid

ents

of

old

people

s h

om

es

were

dependent on

socia

l w

elfare

.

All

pay s

om

e c

ontr

i-

bution to H

and S

C.

No-

FC

s s

een a

s

dis

ruptive-

not con-

sulted in h

ospital

care

, ju

st

pro

vid

e

cle

an laundry

, conta

ct

and s

upport

,

At le

ast

50%

of

the

nurs

ing c

are

sta

ff

em

plo

yed in r

esid

en-

tial in

stitu

tions m

ust

have a

pro

fessio

nal

qualif

ication if

they

care

for

more

than 4

pers

ons in n

eed o

f

care

and if specia

l

care

inte

rventions a

re

necessary

Yes-

LT

CI th

ru’ re

gu-

lations f

or

pro

fes-

sio

nal serv

ice p

rovid

-

ers

that la

y d

ow

n the

conte

nt

of

serv

ices

offere

d, org

aniz

a-

tional m

odes a

nd the

required q

ualif

ications

for

care

rs / n

urs

es

no s

tandard

ized q

ual-

ity c

ontr

ol pro

cedure

s

for

sheltere

d h

ousin

g

and t the q

ualit

y v

ar-

ies g

reatly

Gre

ece

Resid

en

tial-

Estim

ate

less t

han 1

% o

f

65+

. N

GO

s, C

hurc

hes, F

oundations a

nd

private

hom

es –

but no a

dequate

bre

ak-

Min

. in

ille

gal,

cro

wded f

acili

ties

600 €

, av. 1000 –

If O

P h

as inadequate

incom

e, fa

mili

es p

ay.

When in h

ospital F

Cs

Tra

inin

g r

equirem

ents

for

head n

urs

es b

ut

not fo

r assis

tants

. N

o

Min

istr

y h

as a

n In-

specto

rate

but fo

cus

traditio

nally

on e

nvi-

94

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

dow

n o

f num

bers

in e

ach k

ind.

Exact nos. unknow

n s

ince m

any p

laces

not re

gis

tere

d. T

raditio

nally

had to b

e s

elf-

caring b

ut in

cre

asin

g n

um

bers

are

de-

pendent on e

ntr

y a

nd m

any n

ow

effec-

tively

nurs

ing h

om

es.

In a

non r

epre

sent stu

dy o

f th

ose w

ith a

FC

17%

of th

e m

en a

nd 2

9%

of th

e

wom

en b

ein

g c

are

d for

spent th

eir term

i-

nal phase in a

nurs

ing h

om

e o

r clin

ic

Pri

vate

clin

ics –

num

bers

no k

now

n.

Sh

elt

ere

d h

ou

sin

g –

no

Ho

sp

ital sta

y –

decre

asin

g length

of sta

y

for

OP

Reh

ab

ilit

ati

on

– 3

public

+ p

rivate

units.

Hig

h d

em

and, in

adequate

covera

ge, no

hom

e r

ehab s

erv

ice, although s

om

e in-

sura

nce c

over fo

r lim

ited p

hysio

thera

py a

t

hom

e.

Ho

sp

ice –

pallia

tive c

are

– for

cancer

patients

Dem

en

tia -

recent develo

pm

ent of re

spite

care

and F

C s

upport

by A

lzheim

er

gro

ups

1400 s

ingle

room

s,

best re

sid

ential

hom

es a

ppro

x 2

000 €

- cost depends o

n the

degre

e o

f depend-

ency.

IKA

pensio

ns

are

appro

xim

ate

ly

500 €

p.m

.. O

nly

in

exceptional cases w

ill

the Insura

nce F

unds

pay t

he f

ull

costs

.

Private

clinic

s –

In-

sura

nce f

unds w

ill pay

for m

any o

f costs

for

term

inally

ill

patients

,

have to o

ffer

pra

ctical

help

in n

urs

ing.

Sm

all

resid

ential

hom

es in local are

as,

inclu

din

g r

eligio

us

hom

es, als

o u

sed b

y

work

ing f

am

ily c

are

rs

when c

an’t a

ccom

-

modate

the O

P w

ith

them

- F

C w

ho a

re

pro

xim

ate

oft

en p

ro-

vid

e p

ers

onal care

,

food a

nd c

om

pany for

the O

P w

hen the

care

r is

not at w

ork

.

Most re

sid

ential

hom

es e

ncoura

ge the

active p

art

icip

ation o

f

fam

ily c

are

rs a

s it

both

eases the c

are

tasks f

or

the s

taff a

nd

impro

ves the w

ell-

bein

g o

f th

e o

lder

pers

on.

min

imum

num

bers

of

sta

ffin

g f

or

hom

es.

ronm

ent and s

pace

sta

ndard

s r

ath

er

than

quality

of care

.

Fam

ilies o

ften v

ery

concern

ed w

ith level

and q

uality

of care

.

Private

clinic

s r

egis

-

tere

d w

ith M

inis

try

and h

ave b

asic

levels

of m

edic

al and n

urs

-

ing s

taff, although for

very

inte

nsiv

e c

are

needs, it is o

ften s

till

necessary

to e

mplo

y

private

nurs

ing a

ssis

-

tants

as in s

tate

hos-

pitals

et e

Hungary

R

esid

en

tial 3.2

% o

ver

60. In

1993 2

8 7

42

pers

ons liv

ed in s

uch institu

tions, by 2

001

was 4

1%

hig

her)

. U

nm

et needs-.

In 2

000

11 7

67 p

ers

ons w

ere

on the w

aitin

g lis

t fo

r

pla

ces, and 5

3%

waitin

g >

a y

ear

Founda-

tions, churc

hes, private

busin

esses Insti-

tutions m

ay s

et oth

er

crite

ria, e.g

. age.

New

resid

ential hom

e, younger

old

er

per-

in r

ehabili

tation insti-

tutions the fee

charg

ed m

ay n

ot

exceed 8

0%

of in

-

com

e o

f th

e r

ecip

ient

of care

Private

or

NG

O insti-

tutions w

hic

h d

o n

ot

Not financia

l

In h

ospitals

FC

s h

ave

to h

elp

because o

f

nurs

ing s

hort

ages.

Costs

of

payin

g for

better

medic

ines,

toile

t needs, better

meals

.

Has b

egun

Qualit

ative d

evelo

p-

ment can a

lso b

e

observ

ed in the c

ase

of re

sid

ential hom

es,

especia

lly in the w

ake

of in

vestigations b

y

the o

mbudsm

an a

nd

as a

result o

f fu

rther

95

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

sons, built by foundations a

nd c

hurc

hes

are

of a h

igh s

tandard

(in

contr

ast to

room

s for

4-1

6 p

ers

ons in the s

tate

hom

e)

and p

rovid

e g

ood s

erv

ices. – W

ith m

ort

al-

ity r

ate

dro

ppin

g a

nd institu

tions’ “t

urn

over

speed”

reduced. C

onsequently they w

ere

forc

ed to r

ais

e the a

ge for

entr

y (

e.g

. to

70

or

75 y

ears

) and a

lso the s

um

to b

e p

aid

on e

ntr

y.

Resp

ite U

sed for

respite c

are

especia

lly

by u

rban O

P.

Sh

elt

ere

d h

ou

sin

g

Ho

sp

ital sta

y –

fre

quent early d

ischarg

e

because o

f hig

h c

osts

Reh

ab

ilit

ati

on

– s

om

e, in

adequate

Ho

sp

ice –

pallia

tive c

are

– y

es

Dem

en

tia

wis

h to r

eceiv

e the

sta

te p

er

capita fund-

ing a

re fre

e to s

et an

entr

y c

harg

e u

sually

am

ounting to s

evera

l

mill

ion H

UF

(or

the

transfe

r of an a

part

-

ment th

ey a

re a

ble

to

sell),

as w

ell

as a

month

ly f

ee f

or

the

care

.= 1

%

train

ing for

the s

taff,

but th

e s

tandard

of

care

depended to a

larg

e e

xte

nt on the

main

tain

ing b

ody, th

e

age o

f th

e institu

tion

and the a

ttitude o

f its

head.

Irela

nd

Resid

en

tial – L

td p

ublic

and m

ain

ly p

ri-

vate

6.1

96 b

eds in p

rivate

and v

olu

nta

ry

hom

es w

ith p

ublic

fin

ance s

upport

+ 1

,281

contr

act beds w

ith c

ontr

act of health

board

with p

rivate

secto

r as p

rivate

care

.

Plu

s 3

85 furt

her

beds. 80%

of all

beds g

et

public f

undin

g.

4775 b

eds in p

rivate

and v

olu

nta

ry h

om

es

90-9

5%

occupancy r

ate

s. M

aj over

75,

only

16%

aged 6

5-7

5

Sh

elt

ere

d h

ou

sin

g -

yes

Ho

sp

ital sta

y

Means teste

d, client

or

fam

ily m

ay p

ay

costs

Nurs

ing h

om

e

care

is m

eans teste

d.

Tax r

elief allow

ed to

clie

nt or fa

mily

.

Som

e s

uperv

isio

n.

Lia

ison w

ith c

are

sta

ff.

The m

ajo

rity

of em

-

plo

yed s

taff

are

pro

-

fessio

nally q

ualif

ied.

Specia

list tr

ain

ing is

available

for

palli

ative

care

and d

em

entia

care

. T

rain

ing in n

urs

-

ing s

taff a

nd c

are

sta

ff

is c

om

puls

ory

There

is n

o n

ational

nurs

ing h

om

e inspec-

tora

te a

t th

e m

om

ent,

although p

lans for

a

nurs

ing h

om

e inspec-

tora

te a

re b

ein

g m

ade

and legis

lation is b

e-

ing d

raft

ed (

2005).

Private

nurs

ing

hom

es m

ust be r

egis

-

tere

d w

ith the H

SE

and a

re r

equired to

meet cert

ain

sta

n-

dard

s. H

ow

ever,

in-

96

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Reh

ab

ilit

ati

on

- y

es

Ho

sp

ice -

pallia

tive c

are

– y

es 6

centr

es,

7 s

pecia

lists

+ s

pecia

list palli

ative c

are

team

s a

nd s

upport

ed b

y N

GO

s

Dem

en

tia is u

nder

the r

em

it o

f P

sychia

try

of O

ld A

ge s

erv

ices p

rovid

ed b

y the

Health S

erv

ice E

xecutive. P

rovid

ed o

n in-

and o

ut patient basis

in n

on-a

cute

hospi-

tals

. P

sychia

try o

f O

ld A

ge s

erv

ices a

lso

available

in the c

om

munity, although s

uf-

fers

fro

m s

taff s

hort

ages. V

olu

nta

ry o

r-

ganis

ations a

lso p

rovid

e d

em

entia s

er-

vic

es s

uch a

s d

ay c

are

, hom

e c

are

, and

respite c

are

.

spection s

taff a

re

over-

str

etc

hed a

nd

under-

funded a

nd

care

sta

ndard

s c

an

vary

. T

he Irish H

os-

pic

e F

oundation h

as

published s

tandard

s

for

palli

ative a

nd b

e-

reavem

ent care

.

Italy

R

esid

en

tial 2%

of 65+ in h

om

es. B

ed

vacancie

s in n

urs

ing h

om

es, ra

ngin

g fro

m

34 p

er

1000 inhabitants

in the N

ort

h, to

13

in C

entr

al Italy

, and d

ow

n to 1

0 in the

South

. O

f all

OP

care

d f

or

in r

esid

ential

sett

ings,

73%

liv

e in the N

ort

h, 15%

in

Centr

al Italy

and 1

2%

in the S

outh

38%

of

resid

ential fa

cili

ties f

or

OP

are

public, 58%

are

private

and the r

em

ain

ing

4%

are

mix

ed s

tructu

res, w

ith r

ele

vant

diffe

rences b

etw

een s

ocia

l–assis

tance

and h

ealth-c

are

str

uctu

res, w

here

not fo

r -

pro

fit in

stitu

tions h

ave a

42%

and 2

5.8

%

pre

sence,

respectively

OP

more

depend-

ent in

all

institu

tions.

Resp

ite –

som

e

Sh

elt

ere

d h

ou

sin

g –

socia

l housin

g

gra

dually b

ecom

es m

ore

used b

y h

igher

The f

am

ily c

osts

for

private

care

at hom

e

are

often low

er

than

the r

esid

ential fe

es

Only

5%

of eld

erly

people

who m

ake u

se

of serv

ices o

ffere

d b

y

resid

ential care

do n

ot

pay a

nyth

ing, w

hilst

expenses f

or

62%

of

resid

ents

fall

entire

ly

upon the fam

ily,

where

as in 3

3%

of

cases h

ealth c

are

costs

are

part

ially

covere

d b

y the N

a-

tional H

ealth S

yste

m

fund.

Fam

ilies o

f 35-4

0%

of

the r

esid

ents

pro

bably

contr

ibute

equiv

ale

nt

to 2

50-5

00 €

p.m

..

Especia

lly in S

. Italy

and f

or

severe

ly a

f-

fecte

d O

P r

ela

tives

often r

equired b

oth

in

hospitals

and in m

any

resid

ential hom

es to

pro

vid

e n

ight assis

-

tance a

nd p

ers

onal

care

.

FC

support

may b

e

the c

onditio

n s

ine q

ua

non f

or

a O

P’s

adm

is-

sio

n to the c

aring

facili

ty b

ut has p

osi-

tive a

spects

to e

nsure

Yes –

but th

ough in

law

difficultie

s in g

et-

ting a

ll sta

ff tra

ined

because o

f short

ages.

Resid

ential hom

es

desig

ned f

or

self-

suffic

ient eld

erly p

eo-

ple

are

im

pro

perly

transfo

rmed into

long

care

hospital centr

es

97

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

dependent.

Ho

sp

ital sta

y –

1 / 3

of

beds for

severe

ly

ill p

eople

occupie

d b

y >

65 p

atients

Av.

period o

f sta

y is s

hort

er

in p

ublic

V p

rivate

str

uctu

res =

27 d

ays V

91 d

ays.

Reh

ab

ilit

ati

on

– y

es

Ho

sp

ice –

pallia

tive c

are

Dem

en

tia N

GO

led p

roje

ct in

itia

tives

non a

bandonm

ent

Luxem

bourg

Resid

en

tial -

4328 b

eds in 3

5 inte

gra

ted

cente

rs a

nd 1

4 n

urs

ing h

om

es. i.e. 63,1

40

aged 6

5+

- = 6

.8%

- (

hig

her

than

neig

hbouring c

ountr

ies w

hic

h h

ave 4

%)

One o

f hig

hest le

vels

of

availabili

ty in E

U.

Expandin

g b

y 1

350 u

nits.

Resp

ite –

yes

Sh

elt

ere

d h

ou

sin

g –

esp. fo

r m

enta

l

dis

able

d h

ave s

tart

ed Inte

gra

ted C

entr

e

for

Old

er

People

with D

isabili

ties o

pened,

with c

apacity for

56 s

enio

r re

sid

ents

,

managed b

y the “

Fondation K

raiz

bie

rg”.

Ho

sp

ital sta

y

Reh

ab

ilit

ati

on

- y

es

Ho

sp

ice-

pallia

tive c

are

yes, availa

ble

and s

pecia

l tr

ain

ing c

ours

es f

or

sta

ff in

palli

ative c

are

availa

ble

fro

m M

in. of

Health.

Dem

en

tia

35.8

2. € p

er

hour

vers

us 4

8 €

for

hom

e

care

Hig

h incom

es m

ean

most people

can a

f-

ford

it. A

nd N

at F

und

of S

olid

arity

pays a

ny

additio

nal costs

if

som

eone c

an’t a

fford

full

costs

. (7

00 b

ene-

ficia

ries)

But adequate

ly

funded a

nd s

taff w

ell

paid

No. F

undin

g is to O

P

thro

ugh the N

ational

Solid

arity

Fund

More

than h

alf a

re

fore

ign w

ork

ers

(main

ly E

U) in

the

care

and s

ocia

l sec-

tor.

Yes –

if

not already

qualif

ied, pro

fessio

nal

train

ing f

or

assis

tant

nurs

es a

vaila

ble

.

Specia

l cours

es in

palli

ative c

are

avail-

able

fro

m M

in. of

Health. E

ach e

m-

plo

yer

in the s

ocia

l

secto

r has to g

uara

n-

tee 2

0 h

ours

of

ad-

vanced tra

inin

g –

thus

continuous tra

inin

g is

com

puls

ory

Yes –

A Q

ualit

y m

an-

agem

ent syste

m b

e-

ing d

evelo

ped.

Malta

Resid

en

tial >

5%

of O

P 6

5+

liv

e in g

ov-

ern

ment and p

rivate

run h

om

es, but de-

mand incre

asin

g.

Private

rate

s a

re

hig

her

than those in

Sta

te o

wned o

r

Good c

are

but F

Cs

import

ant in

pro

vid

ing

psycholo

gic

al sup-

The m

ajo

rity

of em

-

plo

yed s

taff

are

pro

-

fessio

nally q

ualif

ied.

Main

ly s

tandard

s o

f

accom

modation,

cle

anlin

ess e

tc.

98

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Private

hom

es (

10)

2 o

f th

e 7

Sta

te-o

wned r

esid

ential hom

es

adm

inis

tere

d p

rivate

ly. 18 C

hurc

h-r

un

resid

ential hom

es p

rovid

ing a

round 6

00

beds.

Assessm

ent R

ehabili

tation T

eam

(AR

Team

) decid

es o

n e

ligib

ility

and p

rior-

ity o

f cases. T

o e

nte

r one o

f th

ese h

om

es,

an e

lderly p

ers

on m

ust be fully

mobile

and

capable

of liv

ing independently. W

ith o

ne

exception, th

ese h

om

es d

o n

ot have a

nurs

ing w

ing. A

dependent O

P g

oes to

a p

lace w

here

nurs

ing f

acili

ties a

re a

vail-

able

, such a

s S

VP

R o

r one o

f th

e p

rivate

hom

es.

Resp

ite R

esl. H

om

es u

sed a

lso f

or

Res-

pite c

are

.

Sh

elt

ere

d h

ou

sin

g

Ho

sp

ital sta

y

Reh

ab

ilit

ati

on

– Y

es

Ho

sp

ice –

palli

ative c

are

Dem

en

tia

Churc

h r

un r

esid

ential

hom

es d

ependin

g o

n

levels

of ‘h

ote

l’ ac-

com

modation a

nd

nurs

ing s

erv

ices r

e-

quired. C

osts

18 to

46 €

daily

.

In the larg

est sta

te

institu

tion w

ith m

ore

than 1

000 b

eds r

esi-

dent

pays 8

0%

of

his

tota

l in

com

e b

ut m

ust

still

have 1

380 €

p.a

.

for

self. In

oth

er

hom

es the O

P p

ays

60%

of his

tota

l in

-

com

e,

with s

am

e

conditio

n. E

stim

ate

d

actu

al daily

cost per

resid

ent am

ounts

to €

48.3

0 –

subsid

ized b

y

Sta

te.

Less n

uns m

eans

hig

her

use o

f la

y p

ro-

fessio

nals

and a

s a

result c

osts

are

ris

ing

port

, acting a

s inte

r-

media

ries, pro

vid

ers

of in

form

ation,

Als

o m

undane c

aring

tasks f

or

the O

P e

.g.

as w

ashin

g their

clo

thes, pers

onal

care

, cookin

g

meals

, housekeepin

g,

accom

panyin

g the

patient to

appoin

t-

ments

, and takin

g

specim

ens a

nd c

ol-

lecting r

esults.

The o

thers

, m

ain

ly

those o

ffering ‘hote

l

type’ serv

ices r

eceiv

e

in-h

ouse tra

inin

g

Neth

erlands

Resid

en

tial 5%

of O

P liv

e in r

esid

ential

hom

es, and a

bout 2,5

% in n

urs

ing h

om

es

Respite -

yes

Sh

elt

ere

d h

ou

sin

g

Ho

sp

ital sta

y 1

2%

aged 6

5-

74 a

dm

itte

d;

13%

75 +

V a

ge 5

5-6

4 (

7%

) and 3

5-

54

Incom

e r

ela

ted L

ow

co-p

aym

ent (m

ax.

€ 6

85.4

0 p

.m.)

, H

igh

co-p

aym

ent (m

ax.

€ 1

,700.-

p.m

.

1 in 1

0 F

C g

ive c

are

to p

eople

liv

ing in

health c

are

facili

ties

or

specia

l housin

g

facili

ties (

financia

l

affairs, gro

ceries,

transport

, w

ashin

g /

Resid

ential hom

es

have low

level of

train

ed s

taff

Nurs

ing h

om

es for

dependent have

train

ed s

taff

Larg

e s

erv

ice o

rgani-

zations h

ave o

wn

contr

ols

, but sm

all

org

aniz

ations d

o n

ot.

99

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

(5%

). 2

5%

75 y

ears

+ c

onta

cte

d a

medi-

cal specia

list

Reh

ab

ilit

ati

on

Res. H

om

es u

sed f

or

re-

habili

tation o

f both

eld

erly a

nd y

ounger

patients

, and in d

iagnosis

and functional

assessm

ent.

Ho

sp

ice -

pallia

tive c

are

– y

es a

vaila

ble

.

Dem

en

tia

bath

ing, (u

n-d

ressin

g,

feedin

g).

In h

olid

ay p

eriods

som

e n

urs

ing a

nd

resid

ential hom

es a

sk

for

extr

a h

elp

fro

m

FC

s b

ecause o

f per-

sonnel short

ages

Norw

ay

Resid

en

tial 9 / 1

0 o

lder

pare

nts

pre

fer

a

resid

ential settin

g if th

ey c

an n

o longer

live b

y them

selv

es. M

any u

nits a

nd s

hel-

tere

d h

ousin

g -

5.2

% o

f to

tal 67+

in s

hel-

tere

d h

ousin

g (

15.1

% b

y a

ge 9

0),

6.6

all

aged 6

7+

, by a

ge 9

0+

was 3

8.5

%. In

-

cre

ase in s

heltere

d h

ousin

g a

nd d

ecre

ase

in n

urs

ing h

om

es. S

hort

age o

f beds h

as

declined.

Adm

issio

n –

is d

egre

e o

f dependency.

Sh

elt

ere

d h

ou

sin

g 2

000 / 2

001, 80%

LA

s h

ad s

pecia

l units w

ith s

heltere

d liv

ing

for

pers

ons w

ith d

em

en

tia, (V

70%

1996)

LA

s w

ithout such u

nits a

re s

mall

(less

than 2

500 inhabitants

)

Resp

ite 5

5%

of LA

s h

ad s

pecia

l re

spite

arr

angem

ents

for

pers

ons w

ith d

em

en

tia.

Hospital sta

y –

earlie

r re

lease

Reh

ab

ilit

ati

on

– e

very

where

but a b

ed

short

age

Ho

sp

ice –

pallia

tive c

are

Go

od

/ In

no

vati

ve p

racti

ce -

2 L

As h

ave

Paym

ent re

late

s to

OP

incom

e =

75%

of

baseline o

f th

e N

a-

tional S

.I. € 6

,600,

supple

mente

d w

ith

maxim

um

85%

of

oth

er

form

s o

f in

com

e

(if any),

aft

er

taxes.

There

is a

basic

ex-

em

ption o

f € 7

30. O

n

avera

ge, users

pay

about one third o

f th

e

tota

l costs

for

nurs

ing

hom

e. Low

incom

e

resid

ents

pay less

Tota

l costs

vary

be-

tween m

unic

ipalit

ies.

(€ 5

4.9

00)

in 2

004.

Irre

spective o

f in

com

e

and c

osts

, every

resi-

dent is

guara

nte

ed a

min

imum

am

ount

at

ow

n, fr

ee d

isposal,

about € 2

50 p

.m.

Good / Innovative

pra

ctice -

FC

s f

ree t

o

develo

p their "

care

-

giv

er

care

ers

" in

the

institu

tional settin

g.

E.g

. spouses, vis

it

part

ners

as a

part

of

their d

aily

routines

giv

e p

ers

onal care

and a

ssis

t at m

eals

.

As a

n ideal, s

taff

and

FC

s h

ave initia

l and

follo

w-u

p m

eetings to

cla

rify

expecta

tions

and c

onsid

er

the in-

volv

em

ent of

the F

C.

In p

rincip

le, it is u

p to

the f

am

ily c

are

giv

er

to

decid

e h

ow

much

care

they w

ant to

giv

e

and the e

xte

nt to

whic

h they k

eep o

n to

the r

ela

tionship

.

Lack o

f tr

ain

ed n

urs

-

ing a

nd c

are

pers

on-

nel.

Action P

lan h

as f

o-

cused o

n m

odern

isin

g

nurs

ing h

om

es +

with

sin

gle

room

s for

all

OP

. LA

s r

esponsib

le

for

qualit

y a

nd s

tan-

dard

s o

f prim

ary

health a

nd s

ocia

l

serv

ices, re

gard

less

of w

ho c

arr

ies o

ut th

e

serv

ices, cpr.

super-

vis

ion legis

lation.

Contr

ol and s

uperv

i-

sio

n a

re s

hare

d b

e-

tween the o

ffic

es o

f

the C

ounty

govern

or

and the C

ounty

phy-

sic

ian

100

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

org

aniz

ed L

TC

in institu

tions b

uilt in

Spain

, as p

art

of th

eir r

egula

r old

age c

are

serv

ices

Pola

nd

Resid

en

tial – 7

8,9

35 p

eople

inclu

din

g

10.1

14 b

edridden; 23.6

% a

ged 6

1-7

4 a

nd

29.8

% a

ged 7

5 a

nd m

ore

. D

espite in-

cre

ase in p

laces m

ay w

aitin

g to b

e a

dm

it-

ted. 811 h

om

es 2

1.1

pla

ces p

er

10 thou-

sand p

eople

. T

his

has incre

ased b

y 3

.3

pla

ces s

ince 1

990. 18.6

to 2

3.9

per

10,0

00 p

eople

post-

pro

duction a

ge. V

.

uneven r

egio

nal dis

trib

ution though m

ore

eld

erly a

lso h

as m

ore

institu

tions. E

x m

u-

ral acti

vit

ies for

oth

er

OP

e.g

. m

eal,

thera

peutic a

ctivitie

s s

imila

r to

the d

ay

care

centr

es.

Resp

ite –

no

Sh

elt

ere

d h

ou

sin

g –

No s

heltere

d h

ous-

ing

Ho

sp

ital sta

y

Reh

ab

ilit

ati

on

Ho

sp

ice –

pallia

tive c

are

The c

ost

of

sta

y c

ov-

ere

d b

y the inhabi-

tant’s o

wn p

ensio

n

(3 / 4

of th

e p

ensio

n)

and b

y their fam

ilies,

but sin

ce this

rare

ly

covers

costs

main

ly

by s

ocia

l care

funds.

75%

hom

es fin

anced

by L

As a

nd m

anaged

by them

. O

ther

institu

-

tions a

re m

anaged b

y

churc

h a

nd N

GO

s.

Over

130 p

rivate

care

hom

es h

ave a

tota

l of

2300 p

laces-

these

vary

in p

rice a

nd a

re

more

expensiv

e. LA

s

adm

it b

ased o

n c

rite

-

ria (

medic

al plu

s loss

of fitn

ess (

need f

or

nurs

ing c

are

) or

de-

clin

e in s

ocia

l condi-

tions (

loneliness, la

ck

of fa

mily

, la

ck o

f abil-

ity to m

anage the

household

, very

low

incom

e e

tc.)

Yes t

o c

osts

if

they

can a

fford

it. –

Just

1%

.

FC

s d

o n

ot care

in the

institu

tion o

r in

a h

os-

pital – c

onflic

ts w

ith

pro

f. s

taff.

Yes

Varied b

ut im

pro

vin

g

sta

ndard

. P

rivate

ly

ow

ned h

om

es f

or

the

aged a

re n

ot under

superv

isio

n o

f socia

l

policy o

ffic

ers

(th

ere

are

docum

ente

d

cases o

f extr

em

e

negle

ct in

the p

ri-

vate

ly o

wned h

om

es).

Care

institu

tions o

r-

ganis

ed b

y N

GO

s a

re

usually s

uperv

ised b

y

local socia

l centr

es.

Port

ugal

Resid

en

tial 1,5

50 r

esid

ential hom

es a

nd

OP

hom

es w

ith 9

5.8

% u

tiliz

ation / 5

0,6

07

Main

ly p

rivate

, S

om

e

not fo

r pro

fit financed

Not active o

r part

ner-

ship

, but in

stitu

tion

No.

Heads o

f in

stitu

tions

Curr

ent tr

ansfo

rma-

tion into

inte

nsiv

e

101

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

65+

, m

ore

wom

en a

t all

ages. 3.3

% o

f

pop.

848 O

P H

om

es, 56 R

esid

ential hom

es.

28,8

02 o

n w

aitin

g lis

t in

1993

Sh

elt

ere

d h

ou

sin

g y

es, w

ith c

urr

ent

transfo

rmation o

f R

esid

ential H

om

es

Ho

sp

ital sta

y

Reh

ab

ilit

ati

on

very

few

serv

ices:1

7-2

7%

of aged o

ver

55, had a

ccess to r

ehabili

ta-

tion.

Ho

sp

ice –

pallia

tive c

are

Dem

en

tia –

no

by s

tate

.

Pre

f. for

sin

gle

eld

erly

with low

incom

e a

nd

without

FC

in O

ld

People

’s H

om

es

Private

OP

Hom

es

are

v.

expensiv

e.

ask F

C to p

art

icip

ate

in o

utings, fe

stivals

.

are

qualif

ied.

Encoura

gem

ent of

train

ing thru

pro

-

gra

mm

e o

f In

tegra

ted

support

for

the E

ld-

erly.

nurs

ing h

om

es o

r

sheltere

d h

ousin

g.

Gra

ndpare

nt P

lan

under

develo

pm

ent to

develo

p m

easure

s f

or

the c

ert

ific

ation o

f

institu

tional qualit

y.

Slo

venia

R

esid

en

tial 52 s

tate

hom

es.

4.3

% o

f O

P

= 1

2,0

00. O

P h

om

es

are

full

and long w

ait-

ing p

eriods.

1 / 4

of care

d-for people

at th

ese

hom

es

die

each y

ear. Incre

asi

ngly

pla

ces

with v

. dependent needin

g h

ealth

care

. A

v

capaci

ty a

round 2

00 b

eds;

low

est

60 b

eds;

av., room

s have 1

.97 b

eds

Som

e p

rivate

hom

es w

ith c

oncessio

n (

8)

resid

ences.

Resp

ite -

New

faci

litie

s are

hote

ls for th

e

eld

erly,

where

OP

live m

ost

ly tem

pora

rily

and

transi

tionally

. T

hey g

ive F

Cs

the c

hance to

take a

tem

pora

ry b

reak

since n

o p

roper re

s-

pite

care

. ‘T

em

pora

ry a

dm

issi

on’ o

nly

avail-

able

in 2

public

secto

r O

P h

om

es

and in

hosp

itals

.

Sh

elt

ere

d h

ou

sin

g –

new

– 3

00 u

nits in 9

pla

ces (

stu

dio

and o

ne-r

oom

apart

ments

,

som

e 2

-room

apart

ments

.) H

igh inte

rest

Private

- has t

o b

e

paid

for.

Entitlem

ent

OP

> 6

5 w

ith m

enta

l /

physic

al pro

ble

ms.

The n

um

ber

of re

cip

i-

ents

of th

ese s

erv

ices

depends o

n their

health c

onditio

ns.

Care

d-f

or

people

pay

for

serv

ices t

hem

-

selv

es if th

ey a

re

financia

lly c

apable

. 2 /

3 O

P in h

om

es e

n-

tire

ly c

overe

d t

he

costs

of

care

fro

m

ow

n r

esourc

es a

nd

with the h

elp

of

rela

-

tives (

out-

of-

pocket

payers

), 2

7.5

% o

f

Earlie

r re

lease f

rom

hospitals

– w

here

FC

do n

ot pla

y a

ny s

up-

port

ing p

art

– a

nd

absence o

f re

hab

facili

ties m

eans F

Cs

faced b

y p

roble

ms o

f

care

.

FC

s e

ncoura

ged to

work

with R

esid

ential.

hom

e –

and m

ore

hom

es w

ork

as tra

in-

ers

/ info

rmation for

FC

s o

f O

P in h

om

e

and in c

om

munity.

Yes, in

stitu

tional care

is p

rovid

ed b

y tra

ined

pers

onnel: s

ocia

l

work

ers

, tr

ain

ed

nurs

es, occupational

thera

pis

ts, physio

-

thera

pis

ts-

they h

ave

finis

hed s

pecia

lized

education / tra

inin

g.

How

ever

these insti-

tutions a

lso e

mplo

y

untr

ain

ed p

ers

onnel:

som

etim

es u

nem

-

plo

yed p

eople

are

offere

d w

ork

in institu

-

tions f

or

a lim

ited

period e

.g. a y

ear.

This

is a

pro

gra

mm

e

to r

educe u

nem

plo

y-

ment, tra

inin

g in c

are

Yes-

hom

es a

re o

f a

hig

h s

tandard

except

for

Hum

an a

spects

–

but th

ey a

re a

lso w

ell

contr

olle

d-

A lot of out

work

with thre

e-

mem

ber

contr

ol

com

mis

sio

ns, ap-

poin

ted b

y the M

inis

-

ter

from

the lis

t of

expert

s, perf

orm

regula

r and irr

egula

r

pro

fessio

nal and a

d-

min

istr

ative c

ontr

ols

.

The lis

t of 45 e

xpert

s,

who a

re a

dditio

nally

train

ed f

or

contr

ol

work

, is

pro

posed b

y

the S

ocia

l C

ham

ber

102

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

but in

realit

y they a

re o

ccupie

d r

ela

tively

slo

wly

because o

f hig

h p

rices, in

appro

pri-

ate

locations a

nd, above a

ll, the fact th

at

people

will not sell

their h

om

e in o

ld a

ge

and m

ove into

a s

malle

r apart

ment

Ho

sp

ital sta

y –

declin

ing

Reh

ab

ilit

ati

on

- inadequate

Ho

sp

ice –

pallia

tive c

are

Dem

en

tia

them

needed h

elp

in

the f

orm

of

a c

o-

paym

ent and o

nly

8%

of people

had the

costs

of

care

entire

ly

paid

. If O

P n

ot able

to

pay, adult c

hildre

n in

the first pla

ce o

r m

u-

nic

ipalit

ies in the s

ec-

ond p

lace a

re law

fully

obliged to h

elp

them

.

People

must

pay f

or

hote

l serv

ices fully

and their p

rices a

re

hig

her

than for

hom

es

of th

e p

ublic

netw

ork

.

Tem

p a

dm

issio

n –

prices p

aid

by O

P /

FC

available

but not

obligato

ry, and thus

not im

ple

mente

d e

ve-

ryw

here

. T

hey d

o

basic

hygie

ne c

are

.

of S

lovenia

.

103

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Spain

R

esid

en

tial T

he r

atio o

f re

sid

ential pla

ces

was 3

.4%

of th

e o

ver

65s, of w

hic

h 1

.26%

were

public-

larg

e incre

ase.

The r

atio o

f public

housin

g u

nder

care

was 0

.05%

of th

e o

ver

65s,. L

arg

e R

e-

gio

nal diffe

rences-

with C

ata

lonia

as

leader.

Liv

ing a

lone, re

gard

less o

f th

e

exis

tence o

f child

ren, and s

erious d

e-

pendency f

acili

tate

access

Sh

elt

ere

d h

ou

sin

g A

lso 4

,280 g

uard

ed

housin

g p

laces in the c

ountr

y d

istr

ibute

d

aro

und 3

96 h

ouses.

Resp

ite t

em

pora

ry s

tays w

as 0

.03%

in

1999, alm

ost entire

ly o

n the c

om

munity o

f

Madrid (

0.1

7%

) and in the B

asque C

oun-

try (

0.0

9%

)

Ho

sp

ital sta

y

Reh

ab

ilit

ati

on

Ho

sp

ice –

pallia

tive c

are

– e

ssentially

not availa

ble

.

Dem

en

tia -

no

Public

-.r

equires h

igh

dependency a

nd little

wealth

Private

- e

xclu

siv

ely

financia

l. 5

8.8

%

pla

ces fin

anced

wholly b

y the u

ser,

and the r

est th

is b

y

the p

ublic

secto

r. 7

0%

of th

e p

ublic

cost fo

r

LT

C is for

resid

ential

serv

ices. U

ser’s c

on-

trib

ution to t

he c

ost

of

the p

ublic

resid

ential

pla

ces lie

s a

t aro

und

75%

of th

eir p

ensio

n.

In 2

000, private

month

ly p

rice a

lmost

900 €

. B

ut diffe

rences

betw

een p

rofit-

makin

g

institu

tions (

som

e

1052 €

p.m

.) a

nd the

rest, n

orm

ally

reli-

gio

us, charg

ing

aro

und h

alf o

f th

e

oth

ers

. P

ublic

resi-

dences in 2

000 w

ere

702 €

. A

v. P

rice =

42%

of hig

hest aver-

age s

ala

ry a

nd 6

3%

of th

e low

est avera

ge

sala

ry

Yes in h

ospitals

- help

to m

ain

tain

hygie

ne,

mora

l support

and

genera

l superv

isio

n o

f

their n

eeds.

For

hig

her

level sta

ff it

exis

ts

Main

ly b

y R

egio

ns

usin

g a

dm

inis

trative

crite

ria -

str

uctu

ral

(location, in

tern

al

dis

trib

ution, fa

cili

ties,

serv

ices, etc

.) a

nd

functional (inte

rnal

regula

tions, prices,

fire

pre

vention, pro

-

gra

mm

ing).

Sw

eden

Resid

en

tial /

Sh

elt

ere

d h

ou

sin

g –

Under

3 types o

f cost: h

ous-

Not expecte

d though

50%

care

pers

onnel

Yes m

unic

ipalit

y a

nd

104

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

one “

um

bre

lla”

headin

g; “s

pecia

l housin

g”

with s

erv

ice a

nd c

are

for O

P c

om

prisin

g:

nurs

ing h

om

es, O

A h

om

es, serv

ice

houses, gro

up h

om

es U

ntil early ‘80s,

institu

tional care

expanded w

ith c

hanges

in p

opula

tion. B

ut sin

ce s

tagnate

d. In

2003, 110 9

00 p

ers

ons liv

ing in d

iffe

rent

form

s o

f in

stitu

tional care

or

in “

specia

l

housin

g”

for

OP

= s

erv

ice c

overa

ge o

f

7.2

% o

f 65 y

rs+

and 1

9%

am

ong those 8

0

yrs

+.

Just

13%

of

OP

in p

rivate

care

.

Ho

sp

ital sta

y -

Earlie

r dis

charg

es f

rom

hospital m

eans O

P a

re m

ore

fra

il w

hen

goin

g into

oth

er

form

s o

f sheltere

d h

ous-

ing o

r goin

g h

om

e.

Reh

ab

ilit

ati

on

– thru

’ P

HC

Ho

sp

ice –

pallia

tive c

are

– P

alli

ative

care

availa

ble

thro

ughout th

e c

ountr

y.

Dem

en

tia –

25 0

00 b

eds in g

roup h

om

es

ing, m

eals

, and c

are

.

Av. net-

incom

e

am

ong O

P is 8

500

SE

K p

.m.. T

he a

ver-

age c

ost fo

r housin

g

is e

stim

ate

d to 2

500

SE

K, fo

od / m

eals

to

2 4

00 S

EK

and c

ost

for

care

at 500 S

EK

p.m

.. O

n a

v. 5 4

00

SE

K c

are

p.m

. or

alm

ost tw

o thirds o

f

incom

e p

rocess o

f

needs a

ssessm

ent,

carr

ied o

ut by the

munic

ipal care

man-

ager.

Access c

rite

ria

may a

nd d

o v

ery

much d

iffe

r fr

om

one

munic

ipalit

y to a

n-

oth

er.

How

ever,

the

level of

dependency

and d

egre

e o

f cogni-

tive im

pairm

ent is

often d

ecis

ive.

Innovative a

spects

-

Adm

issio

n is n

ot

based o

n m

eans-

testing.

fam

ilies d

o p

art

ici-

pate

. In

recent years

there

is a

shift in

atti-

tudes a

nd c

are

per-

sonnel are

more

and

more

focusin

g o

n the

(form

er)

care

r, to

colla

bora

te a

nd c

re-

ate

“care

r- friendly

institu

tions.

has a

t pre

sent th

e

requeste

d tra

inin

g for

the w

ork

(upper

sec-

ondary

school-le

vel),

prim

arily

due to d

iffi-

cultie

s to r

ecru

it c

are

pers

onnel w

ith a

de-

quate

tra

inin

g a

nd

skill

s

national board

s. T

he

monitoring a

uth

orities

work

fro

m the r

e-

gio

nal le

vel.

Sw

itzerland

Resid

en

tial 1422 h

om

es, corr

espondin

g

to 7

6,0

24 T

wo thirds o

f th

e institu

tions a

re

financed b

y p

ublic

funds, one-t

hird b

y

private

foundations.

Inadequate

sta

ffin

g –

mig

rant w

ork

ers

re-

sort

ed

105

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Resp

ite –

yes –

in h

ospitals

and s

om

e

canto

ns h

ave h

oste

ls

Sh

elt

ere

d h

ou

sin

g –

no d

ata

Ho

sp

ital sta

y

Reh

ab

ilit

ati

on

Ho

sp

ice –

pallia

tive c

are

Dem

en

tia –

not in

institu

tions

UK

R

esid

en

tial-

Betw

een 2

000 a

nd 2

001 a

3%

decre

ase in r

esid

ential care

hom

es

and a

decre

ase o

f 3%

in n

urs

ing h

om

es

and p

rivate

hospitals

and c

linic

s. O

ver

half

(54%

) of

support

ed r

esid

ents

were

in in-

dependent re

sid

ential care

hom

es, 27%

were

in independent nurs

ing h

om

es a

nd

16%

were

in L

ocal auth

ority

sta

ffed

hom

es. M

aj over

85+

There

were

431,2

00 r

esid

ential pla

ces in

24,1

00 r

esid

ential care

hom

es a

nd

186,8

00 r

egis

tere

d b

eds in 5

,700 n

urs

ing

hom

es a

nd p

rivate

hospitals

and c

linic

s.

Resp

ite –

wid

espre

ad

Sh

elt

ere

d h

ou

sin

g-

3.5

% o

f people

aged

65 to 6

9 to 1

9%

aged 8

5

Hospital sta

y

Reh

ab

ilit

ati

on

– full

and s

pecia

lised s

er-

vic

es in h

ospitals

, day c

are

and h

om

e

care

team

s. D

anger

of ig

noring the m

ost

frail,

Ho

sp

ice –

pallia

tive c

are

– g

row

th,

NG

Os

Avera

ge c

ost fo

r pri-

vate

resid

ential care

was £

302 p

er

week

and the a

vera

ge c

ost

for

private

nurs

ing

care

was £

422 p

er

week –

OA

P is £

80

per

week. M

ajo

rity

of

the f

undin

g for

the

care

of

old

er

people

is

pro

vid

ed b

y the p

ublic

secto

r.

OP

assets

pay f

or

resid

ential costs

(only

£12000 p

ounds left)

If

indiv

iduals

have m

ore

than £

19,5

00 in c

api-

tal th

en they h

ave t

o

pay t

he f

ull

cost

of

resid

ential or

nurs

ing

hom

e c

are

.

No

In h

ouse tra

inin

g for

low

er

gra

de w

ork

ers

–

pro

fessio

nals

fully

qualif

ied. O

vera

ll lo

w

level of

train

ing f

or

care

work

ers

, w

ith

train

ing f

ocusin

g o

n

min

imal health a

nd

safe

ty r

equirem

ents

,

not philo

sophy o

f care

and the d

evelo

pm

ent

of in

terp

ers

onal skill

s.

New

requirem

ent fo

r

50%

of care

assis

-

tants

to h

ave N

VQ

Level 2 b

y 2

005, pro

-

vid

ing a

sig

nific

ant

challenge f

or

care

hom

es

Nurs

ing h

om

es a

nd

care

hom

es h

ave to

be inspecte

d a

min

i-

mum

of

twic

e a

year.

One inspection is

announced s

o the

hom

es a

re a

ware

when t

hey a

re c

om

-

ing, but one is u

nan-

nounced w

ork

ers

know

they a

re c

om

ing

but in

spection is that

the inspecto

rs turn

up

unannounced. T

he

Care

Sta

ndard

s A

ct

has n

ow

set national

sta

ndard

s s

o that

serv

ices s

hould

be

equiv

ale

nt in

diffe

rent

part

s o

f th

e c

ountr

y.

Inspection r

eport

s a

re

publicly

availa

ble

.

106

Co

un

try

% in

resid

en

tial care

(60+

, 65+

)

Availab

ilit

y

Co

sts

of

resid

en

tial

care

- A

ffo

rdab

ilit

y

Fam

ily c

are

co

ntr

i-

bu

tio

n

Tra

inin

g o

f w

ork

ers

Q

uality

an

d c

on

tro

l

of

resid

en

tial care

Dem

en

tia 1

.5 m

illio

n o

f people

over

85.?

107

5.8

A

nn

ex 8

– M

atr

ix o

f H

om

e B

as

ed

Serv

ices

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Austr

ia

Ho

me H

elp

an

d L

ocal co

ord

inati

on

cen

tres 5

% a

ged 6

5 +

get hom

e c

are

.

17%

am

ong c

are

dependent eld

erly –

gro

wth

slo

wed p

ost 1990s in n

os. of

clie

nts

and s

erv

ice h

ours

.

Few

private

serv

ices

Day C

are

cen

tres –

Yes,

gro

wth

.

Ho

me h

ealt

h c

are

-P

artia

l covera

ge

Dem

en

tia s

erv

ices –

yes a

nd g

row

ing*

- hig

h d

em

and. In

adequate

covera

ge.

Resp

ite c

are

at

ho

me -

in s

om

e r

e-

gio

ns

Serv

ices u

sed b

y 6

0%

of

pers

ons liv

ing

alo

ne a

nd 4

1%

of

pers

ons s

haring a

household

.

Larg

e r

egio

nal dis

parities

in o

rganiz

ational fo

rm,

quality

, develo

pm

ent and

co-o

rdin

ation o

f serv

ices.

HH

usually 2

x w

eek; in

critical cases 5

x w

eek o

r

daily. Low

er

Austr

ia 2

00+

Socia

l S

tations r

un b

y 4

NG

Os a

s o

ne-s

top-s

hops

offering s

erv

ices w

ith

hom

e n

urs

ing a

nd H

H

core

com

pete

ncie

s, +

som

e r

espite c

are

. N

GO

s

pro

vid

e 9

0%

of com

mu-

nity a

nd s

em

i-in

stitu

tional

care

serv

ices; re

imburs

ed

by t

he p

rovin

ce o

r LA

.

With intr

oduction o

f LT

C A

l-

low

ance a

bout 1 / 3

pers

ons

receiv

ing this

cash p

aym

ent

is a

ble

to u

se m

ore

com

mu-

nity s

erv

ices than b

efo

re

27%

of to

tal expenditure

s for

health a

nd s

ocia

l serv

ices is

covere

d b

y c

ontr

ibutions o

f

users

and their r

ela

tives

Inad

eq

uate

qu

ality

co

ntr

ol.

Contr

ol based o

n c

lients

or

fam

ily m

em

bers

’ com

pla

ints

,

periodic

hom

e v

isits, and tele

-

phone c

onta

ct w

ith b

eneficia

r-

ies.

"Str

uctu

ral qualit

y a

ssessm

ent"

used a

dm

inis

tratively

e.g

. cli-

ent / care

r ra

tio e

tc.

NG

Os h

ave inte

rnal qualit

y

assura

nce p

rogra

mm

es b

ut

unknow

n r

esults.

Tra

inin

g-

Adequate

- M

ost

train

ed R

egio

nal sta

ndard

s. N

o

nationw

ide r

egula

tions / s

tan-

dard

s f

or

hom

e &

fam

ily h

elp

-

ers

, geriatr

ic a

ides.

Belg

ium

Ho

me H

elp

an

d L

ocal co

ord

inati

on

cen

tres 4

.9%

of

people

65-7

4 a

nd

26.1

% o

f 75 y

ears

+ u

sed h

om

e h

elp

in

2001.

136 local serv

ice c

entr

es-

Fle

mis

h,

access to p

rofe

ssio

nal care

and info

r-

mation. 53 c

oord

ination c

entr

es in W

al-

loon a

rea. D

em

and e

xceedin

g p

rovi-

sio

n.

M

eans teste

d w

ith r

eductions

for

heavily

dependent. P

riority

to O

P w

ith h

igh d

ependency

and low

incom

e. C

osts

for

the

OP

rela

te to f

am

ily incom

e

Min

. € 0

.50 p

.h., m

ax. re

al

cost of help

i.e

. € 2

2.5

0 p

.h.

av. C

ontr

ibution €

3 p

er

hour,

30%

hig

her

if h

elp

needed 8

pm

-7 a

m o

r S

ats

.; 6

0%

hig

her

Ad

eq

uate

qu

ality

co

ntr

ol.

in

Fla

nders

must

have m

issio

n

sta

tem

ent.

Tra

inin

g-

Good.

All

train

ed

cert

ific

ate

s c

om

puls

ory

.

H &

SC

work

ers

bein

g tra

ined

to w

ork

with F

C

108

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Day C

are

cen

tres –

Yes,

gro

wth

. 0.3

%

of O

P 6

5-

74 y

ears

of

age a

nd 0

.7%

of

OP

75 y

ears

+ in 2

001

Ho

me h

ealt

h c

are

- C

om

pre

hensiv

e

covera

ge

Dem

en

tia s

erv

ices –

yes a

nd g

row

ing

Resp

ite c

are

10,0

00 h

ours

of sit-in

care

p.a

., a

t le

ast half p

rovid

ed b

y v

ol-

unte

ers

.

on S

undays a

nd p

ublic h

oli-

days. V

ery

dependent get

dis

counts

.

Bulg

aria

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres 2

62 F

C s

erv

ice o

ffic

es w

ith 3

5

172 p

laces.

Day C

are

cen

tres –

Yes, gro

wth

; pro

-

vid

e p

ossib

ility

for

day n

urs

ing inclu

din

g

OP

.

Ho

me h

ealt

h c

are

-P

artia

l covera

ge –

inte

gra

ted c

are

with S

S.

Dem

en

tia s

erv

ices –

yes in d

ay c

are

centr

es

Resp

ite c

are

- no though s

um

mer

cam

ps o

ffer

som

e r

elie

f.

Socia

l care

inclu

des b

u-

reaux for

socia

l serv

ices,

hom

es for

eld

erly p

eople

and c

lubs o

f th

e d

isable

d.

Soup k

itchens p

rovid

e

food for

indig

ent pers

ons

and f

am

ilies

Oft

en d

ifficult for

people

to

pay the fees. socia

l assis

-

tance b

enefits

do n

ot cover

costs

.

Inad

eq

uate

qu

ality

co

ntr

ol.

Serv

ice d

om

inate

d b

y q

uantita

-

tive indic

ato

rs

Tra

inin

g –

Good v

irtu

ally

all.

Czech R

epublic

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres a

ppro

x. 10%

uses d

om

icili

ary

serv

ices. 31%

of com

munitie

s c

overe

d

by H

H s

erv

ice-

107 0

00 c

lients

. 26%

lived in s

heltere

d h

ouses, 37%

got

meals

on w

heels

, 24%

vis

ited p

ers

onal

hygie

ne c

entr

es, 13%

used laundry

20%

of

60+

have s

erious

health p

roble

ms

Big

ger

LA

s, esta

blis

h

houses o

f nurs

ing c

are

.

1879 n

urs

es m

ostly o

r-

ganis

ed in p

rivate

or

not

for

pro

fit hom

e c

are

GP

s h

as a

budget perm

itting

hom

e c

are

but expensiv

e for

their b

udgets

and a

gencie

s

are

able

to p

rovid

e n

urs

ing

care

on w

eekends a

nd a

t

nig

hts

. A

nd thus less p

re-

scribed than h

ospital care

–

whic

h d

oes n

ot com

e o

ut of

Inad

eq

uate

qu

ality

co

ntr

ol –

som

e H

H s

erv

ice p

rovid

ers

have o

wn s

tandard

s o

f qualit

y.

Min

istr

y e

labora

ted r

ecom

men-

dations for

genera

l socia

l care

sta

ndard

s o

f qualit

y.

Tra

inin

g-

Inadequate

– m

any

109

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

serv

ices

Private

serv

ices a

lso a

vaila

ble

.

Day C

are

cen

tres –

Som

e d

ay a

nd

week c

entr

es -

0,6

% v

isited d

ay c

entr

es

for

OP

Larg

e d

em

and.

Ho

me h

ealt

h c

are

-P

artia

l covera

ge

Dem

en

tia s

erv

ices –

Yes –

som

e for

FC

s t

hru

’ A

lzheim

er

Associa

tions.

Resp

ite c

are

- A

lzheim

er

linked F

C

only

. O

ther

serv

ices n

ot availa

ble

in

hom

e.

agencie

s.

their b

udget

Gro

wth

in p

rivate

paym

ent fo

r

som

e H

S. e.g

. physio

thera

-

pis

ts

untr

ain

ed. N

o s

yste

m o

f cert

ifi-

cation. C

zech A

ssocia

tion o

f

Nurs

es intr

oduced the s

yste

m

of re

gis

tration a

nd c

ontinual

education o

f nurs

es b

ut not

com

puls

ory

Denm

ark

H

om

e H

elp

and L

ocal co

ord

inati

on

cen

tres 1

5%

60+

get H

H, O

f 700,0

00

67+

, 172,0

00 6

7+ h

ad L

T H

H, +

8-7

000

67+

receiv

e s

hort

-term

HH

. 50%

80+

get LT

HH

., 8

0%

for

pers

onal care

,

20%

pra

ctical help

in the h

om

e (

cle

an-

ing, shoppin

g a

nd laundry

)., 60%

to 8

0+

Gro

wth

of

private

serv

ices

Day C

are

cen

tres -

yes

Hom

e h

ealth c

are

- c

om

pre

hensiv

e

Dem

en

tia s

erv

ices –

incom

ple

te. D

a-

neA

ge r

un v

olu

nte

er-

based r

espite

serv

ice for

FC

s,

Resp

ite c

are

– L

A o

blig

ed u

nder

SS

Law

to p

rovid

e F

Cs c

aring f

/ t w

ith it.

50%

of re

cip

ients

get <

2

hours

per

week, av. hours

per

week is 4

.5 u

nder

80

and 6

.1 for

80+

. 13,0

00

recip

ients

67+

< 2

0 h

rs

p.w

. 1,0

80,0

00 h

ours

of

HH

weekly

100,0

00 p

ers

ons s

uff

er

from

dem

entia

Fre

e, th

ough m

any O

P feel

they s

hould

contr

ibute

to L

A.

Every

one e

ligib

le a

fter

a c

er-

tain

age.

12%

60+

buy in p

rivate

hom

e

help

serv

ices in the h

om

e

while a

n a

dditio

nal 3%

re-

ceiv

e b

oth

public

hom

e-h

elp

serv

ices a

nd

buy in p

rivate

serv

ices

Ad

eq

uate

qu

ality

co

ntr

ol –

Local govern

ment re

searc

h

institu

te (

AK

F)

carr

ies o

ut

evalu

ation a

nd m

onitoring o

f

serv

ices in L

As

Tra

inin

g –

Good, all

train

ed

DaneA

ge tra

ins v

olu

nte

ers

110

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Fin

land

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres 1

0.6

% a

ge 6

5+

get H

H-

4 / 5

from

LA

s,

rest fr

om

private

serv

ices.

Pers

onal care

and s

erv

ice p

lans m

ade

by m

ulti pro

f (H

+S

S)

team

s f

or

pers

ons

in c

ontinuous n

eed f

or

care

. In

cre

ased

focus o

n o

lder

OP

. S

light declin

e in

num

bers

receiv

ing H

H a

nd H

om

e n

urs

-

ing.

Day C

are

cen

tres -

yes p

ublic a

nd

private

incre

asin

g

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e

Dem

en

tia s

erv

ices -

Yes

Resp

ite c

are

– y

es-

NG

Os a

nd L

As –

pro

posed t

o b

e m

andato

ry in f

utu

re f

or

FC

s.

Palli

ative c

are

als

o a

t hom

e.

Hom

e c

are

and h

om

e

nurs

ing 2

x p

er

week.

80%

HH

fro

m L

As, 13%

from

NG

Os,

private

–

10%

Som

e s

erv

ices fre

e e

.g. re

-

hab,

HH

for

term

inally

ill,

nurs

ing c

are

at hom

e, la

b

tests

at hom

e. C

lient fe

es e

.g.

docto

r – 2

2 €

p.a

. m

ax. P

HC

em

erg

ency –

max 1

5 €

for

hom

e n

urs

ing-

dependin

g o

n

household

incom

e a

nd s

ize-

fee v

aries f

rom

11-3

5 €

Tax

reductions a

vaila

ble

for

pur-

chase o

f dom

estic w

ork

.

Som

e c

ontr

ibution f

or

costs

of

day c

are

. (s

om

e fre

e thru

’ LA

,

som

e p

rivate

/ N

GO

and p

aid

for)

Respite p

art

ly p

aid

for

by

FC

.

Go

od

qu

ality

co

ntr

ol

– G

ovt.

pro

vid

es n

ational re

com

menda-

tions-

and c

itiz

ens a

sked r

egu-

larly f

or

com

ments

by L

As.

Tra

inin

g-

Good a

ll tr

ain

ed.

Only

qualif

ied c

an g

et a job.

Have p

roje

ct to

pro

mote

work

abili

ty a

nd m

ain

tain

well b

ein

g

at w

ork

because o

f hig

h turn

over.

Fra

nce

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres –

Access to a

hom

e-h

elp

er

and

oth

er

dom

icili

ary

serv

ices (

nurs

ing e

x-

clu

ded)

is n

ot a legal right.

Day C

are

cen

tres –

som

e, m

ore

needed

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e

inclu

din

g h

ospitaliz

ation a

t hom

e,

para

medic

al serv

ice.

deliv

ery

of dru

gs,

Access is a

legal right.

Dem

en

tia s

erv

ices –

som

e; m

ore

Regio

ns v

ary

- M

ultitude

of private

and p

ublic

or-

ganiz

ations b

ased o

n

diffe

rent financia

l

sourc

es. R

egio

nal varia-

tions in r

ange o

f serv

ices:

oth

er

serv

ices inclu

de

accom

panyin

g, adapta

-

tion o

f th

e h

om

e, adm

inis

-

trative h

elp

, hom

e a

larm

,

keepin

g c

om

pany, m

eals

,

mobile lib

rary

, re

pairs,

shoppin

g, te

chnic

al help

,

Means teste

d f

or

child

ren o

f

OP

.

Nurs

ing a

nd o

ther

para

medi-

cal com

munity s

erv

ices a

re

financed b

y the N

.H.I; hig

her

incom

e r

ecip

ients

can b

e

asked f

or

co-f

inancin

g. H

.H is f

inanced

from

num

ero

us p

rivate

and

public s

ourc

es

Oth

er

serv

ices e

.g. house

ala

rm s

yste

ms o

r m

eals

on

Ad

eq

uate

qu

ality

co

ntr

ol

Regio

nal auth

ority

responsib

le

for m

anagem

ent / superv

isio

n

pro

vid

ed in the A

PA

pro

-

gra

mm

e. S

pecia

l com

pute

r

pro

gra

ms d

evelo

ped for

qualit

y

contr

ol (&

in r

esid

ential care

).

NG

Os e

labora

te w

ith s

taff

, in

di-

vid

ual qualit

y p

lans b

ased o

n

their d

efinitio

ns, aim

s, and e

x-

pecta

tions.

Tra

inin

g. In

adequate

– m

any

111

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

needed

Resp

ite c

are

– y

es a

nd a

lso inclu

des

gra

nny s

itting a

nd d

ay o

r nig

ht care

at

hom

e,

transport

ation, tu

tela

ge

wheels

oft

en fin

anced b

y the

regio

nal govern

ment w

ith c

o-

fundin

g f

rom

recip

ient.

untr

ain

ed L

ow

im

pact of new

care

dip

lom

a a

s u

nskill

ed H

H

sta

ff e

asily fin

d w

ork

& c

ert

ific

a-

tion h

as n

o im

pact on s

ala

ry.

Germ

any

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres 1

in 1

5 a

ged 7

5 +

get hom

e

care

. 18%

of household

s.

Day C

are

cen

tres –

Gro

wth

; availa

ble

if F

C c

annot be g

uara

nte

ed o

r if d

ay

care

is n

ecessary

to e

ase the b

urd

en

on f

am

ily c

are

rs.

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e

Dem

en

tia s

erv

ices -

som

e, in

adequate

and n

eed e

xpandin

g

Resp

ite c

are

- s

om

e

HH

by N

GO

s a

nd p

rofit

com

panie

s a

nd o

ffer

nurs

ing c

are

+ d

iffe

rent

kin

ds o

f H

H. (N

= 3

,622)

said

OP

in n

eed o

f care

or

help

doesn't r

eceiv

e

enough. C

om

ple

menta

ry

serv

ices e

.g. shoppin

g,

vis

itin

g, accom

panyin

g to

docto

rs a

nd o

ther

local

serv

ices, gard

enin

g a

nd

household

main

tenance

not off

ere

d d

espite h

igh

need f

or

such "

light"

ser-

vic

es. R

egio

nal variations

e.g

. B

rem

en S

C s

erv

ices

inclu

de: M

eals

on w

heels

,

FC

counselli

ng / d

iscus-

sio

n g

roups, org

aniz

ing

dom

estic c

are

giv

ing, help

with a

uth

orities, filli

ng

form

s, household

tasks,

laundry

, cookin

g, w

alk

s,

vis

itin

g the d

octo

r and

colle

cting p

rescribed

rem

edie

s

Means teste

d s

ocia

l assis

-

tance is a

vaila

ble

to fin

ance

HH

. T

he O

P o

r F

C c

ontr

act

with the s

ocia

l serv

ice c

entr

e

where

am

ount and type o

f

assis

tance is laid

dow

n. T

he

contr

act costs

20,-

€ p

.m. and

every

serv

ice h

our

after

that

costs

7,1

5 €

. T

his

sum

is

seen a

s c

om

pensation for

the

mostly v

olu

nta

ry w

ork

ers

.

If H

H is n

eeded a

nd n

o n

eed

for

care

dete

rmin

ed then the

OP

or

the F

C m

ust

pay for

it.

Com

munity c

are

and m

eals

on w

heels

are

refinanced

either

by the p

ers

onal contr

i-

butions f

rom

the c

onsum

er

or

part

ly fro

m the s

ocia

l w

elfare

off

ice.

Day c

are

- W

hen O

P a

re

entitled to b

enefits

the L

TC

I

pays a

ll c

are

-rela

ted c

osts

over

an indefinite p

eriod.

Socia

l care

is p

aid

for

as w

ell

as m

edic

al tr

eatm

ent care

Inad

eq

uate

qu

ality

co

ntr

ol

2001 a

dditio

nal le

gis

lation to

guara

nte

e c

ert

ain

qualit

y levels

thro

ugh the L

TC

I. L

TC

I and

serv

ice p

rovid

ers

must agre

e

contr

acts

, re

gula

ting q

ualit

y

sta

ndard

s b

ut th

ese r

efe

r only

to s

tructu

res a

nd p

rocess r

ath

er

than o

utc

om

es o

f care

No g

enera

l m

onitoring b

ody

whic

h lays d

ow

n c

rite

ria for

the

assessm

ent of serv

ice q

ualit

y in

out-

patient health c

are

.

Tra

inin

g –

adequate

–m

ostly

train

ed T

he f

am

ily c

are

r / socia

l

assis

tant are

qualif

ied N

o s

tate

contr

olle

d tra

inin

g p

rogra

mm

e

but specia

list com

munity c

are

train

ing is o

ffere

d b

y v

arious

educational in

stitu

tions.

112

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

113

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Gre

ece

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres A

third (

253)

of LA

s h

ave h

om

e

help

serv

ices in 2

85 o

pera

ting u

nits;

47%

of users

liv

ed a

lone. G

row

th in

covera

ge. S

om

e c

oord

inate

d w

ith s

ocia

l

& h

ealth c

entr

es for

OP

.

Day C

are

cen

tres –

a few

have just

sta

rted

Ho

me h

ealt

h c

are

- Inadequate

Dem

en

tia s

erv

ices –

a few

support

serv

ices

Resp

ite c

are

– n

o s

erv

ices

.

Fre

e a

t poin

t of

use. A

lthough

prim

arily

desig

ned f

or

OP

alo

ne, m

any c

over

FC

s t

hat

need s

upport

.

Private

care

– lim

ited h

om

e

serv

ices e

xcept fo

r re

sid

ent

mig

rant w

ork

ers

– c

osting

appro

x 5

-600 €

wages +

low

rate

of

insura

nce f

or

those

who a

re legitim

ate

. C

heaper

than r

esid

ential care

.

Health c

are

requires info

rmal

paym

ents

especia

lly for

hom

e

vis

its.

Inad

eq

uate

qu

ality

co

ntr

ol

Adm

inis

trative c

rite

ria.

Tra

inin

g –

Ad

eq

uate

. M

ostl

y

train

ed

Hom

e h

elp

serv

ices –

headed b

y tra

ined S

W.

Hungary

H

om

e H

elp

and L

ocal co

ord

inati

on

cen

tres 2

% o

f 60+ r

eceiv

e H

H. 4.5

% o

f

OP

get in

stitu

tional help

fro

m the L

A in

case o

f ill

ness a

nd n

urs

ing; pro

port

ion

hig

hest in

Budapest (8

.2%

) and low

est

in v

illages (

3.3

%).

Day C

are

cen

tres –

som

e h

ave s

tart

ed

Ho

me h

ealt

h c

are

- Inadequate

Dem

en

tia s

erv

ices –

Resp

ite c

are

– s

om

e in d

ay c

are

cen-

tres h

ave s

tart

ed

Run b

y L

As a

s m

andato

ry

serv

ice. LA

may c

ontr

act

out

the t

ask t

o a

civ

il or-

ganis

ation o

r m

ark

et acto

r

under

an a

gre

em

ent or

contr

act. 2

2.9

% o

f all

recip

ients

of H

H liv

ed in

sm

all

agein

g s

ettle

ments

12.6

% o

f all

pers

ons r

e-

ceiv

ing m

eals

. H

ot m

eals

import

ant. f

am

ily h

elp

centr

es s

upport

FC

S o

f all

kin

ds

Fre

e f

or

FC

s. F

undin

g

thro

ugh L

As a

nd n

um

ero

us

NG

Os -

70,0

00– 1

5%

for

health / s

ocia

l care

. F

unded

by s

tate

(26.2

%),

ow

n r

eve-

nues (

52.7

%)

and p

rivate

support

Hungarian R

ed C

ross

and the H

ungarian M

altese

Charity

Serv

ice p

lay im

por-

tant ro

le in p

rovid

ing a

hig

h

sta

ndard

serv

ice fre

e o

f

charg

e a

nd innovato

ry. A

ll

FC

s a

nd O

P in n

eed a

re e

li-

gib

le.

Health c

are

requires info

rmal

paym

ents

Ad

eq

uate

qu

ality

co

ntr

ol

Budapest P

ublic A

dm

inis

tration

Offic

e u

sin

g e

xpert

s o

f 2 n

on-

sta

te institu

tions (

Foundation

for

Socia

l In

novation, H

ungar-

ian A

ssocia

tion o

f S

ocia

l D

irec-

tors

) – H

H a

lso s

uperv

ised b

y

Meth

odolo

gy C

entr

e o

f th

e

Hungarian M

altese C

harity

serv

ice. B

ut in

adequate

inte

gra

-

tion b

etw

een h

ealth a

nd s

ocia

l

serv

ices.

Tra

inin

g –

Ad

eq

uate

. M

ostly

train

ed c

are

rs in the h

om

e h

elp

serv

ice a

re n

urs

es P

art

icip

ation

in tra

inin

g o

n q

ualit

y a

ssura

nce

114

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

. is

im

port

ant

115

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Irela

nd

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres 8

0%

recip

ients

eld

erly, le

ss

than 1

/ 3

0 g

et serv

ice P

rovis

ion b

y

health b

oard

s. 5%

aged 7

5+

. 2007 a

im

is to c

over

25%

of th

ose a

ged 7

5+

(by

2020 e

stim

ate

d 5

% o

f 80+

.pop. and

10%

60+

in n

eed o

f care

) 133,0

00 o

f

whic

h 1

5,9

01 (

2%

govern

ment sup-

port

ed)

Lim

ited p

rivate

hom

e c

are

Day C

are

cen

tres –

. In

adequate

cov-

era

ge e

.g. hom

e c

are

, day c

entr

es.

Larg

e e

xpansio

n p

lanned

Ho

me h

ealt

h c

are

Good G

P, T

hera

py

3%

Dem

en

tia s

erv

ices –

som

e thru

’

NG

Os, m

ore

pla

nned in H

N s

erv

ices

and d

ay c

are

centr

es

Resp

ite c

are

- part

ial -

regio

nal varia-

tions b

y the h

ealth b

oard

or

NG

Os

Inadequate

HH

and D

ay

Care

in c

overa

ge a

nd

am

ount, a

nd g

eogra

phic

al

inequalit

ies. a, ty

pe o

f

conditio

n / d

isabili

ty e

tc.

Uncle

ar

entitlem

ent,

anom

alie

s a

nd inequali-

ties

Chiropody v

ery

popula

r –

16%

(of a s

am

ple

of 937

in H

eS

SO

P s

tudy)

use it

12%

would

have lik

ed to

use it but could

not ac-

cess the s

erv

ice. A

ll

health b

oard

s p

rovid

e H

H

but depends o

n d

em

and.

Barr

ier

to u

se –

lack o

f

know

ledge 1

4%

fin

d it

difficult. S

tigm

a-

30%

for

meals

on w

heels

& 2

0%

Hom

e H

elp

medic

al card

(fo

r lo

w incom

e

indiv

iduals

and fam

ilies a

nd

free for

all

aged 7

0+

)

Private

serv

ices d

epend o

n

incom

e.

Tax r

elief fo

r em

plo

ym

ent of

private

care

r– m

eans-t

esting

Applies t

o a

ll serv

ices

Inad

eq

uate

qu

ality

co

ntr

ol

No

usually in p

lace. Lin

e m

anage-

ment – d

iscre

te r

eport

ing s

ys-

tem

.

Tra

inin

g-

Inadequate

. M

any

untr

ain

ed

The a

bove a

pplie

s to h

om

e

help

only

Work

ers

in d

ay c

are

centr

es,

dem

entia a

nd r

espite s

erv

ices

all

underg

o tra

inin

g.

Italy

H

om

e H

elp

and L

ocal co

ord

inati

on

cen

tres 1

% o

f 65+ g

et hom

e c

are

ser-

vic

es d

iscrim

ination a

gain

st ru

ral are

as

and s

outh

ern

regio

ns. In

adequate

cov-

era

ge a

nd d

em

and e

xceeds p

rovis

ion.

Day C

are

cen

tres inte

gra

ted c

entr

es

are

very

positiv

e

Ho

me h

ealt

h c

are

- p

art

ial, r

egio

nal

diffe

rences

Pro

ble

matic r

ela

tionship

betw

een f

am

ilies a

nd the

public s

erv

ice n

etw

ork

,

where

serv

ices c

onsid

-

ere

d the m

ost help

ful are

,

at th

e s

am

e tim

e, per-

ceiv

ed a

s the m

ost in

-

adequate

(com

munity

care

centr

es, availa

bili

ty

of m

edic

ines, hom

e c

are

Moneta

ry tra

nsf

ers

in s

outh

and r

ura

l are

as a

re o

ften the

only

kin

d o

f support

available

to fam

ily c

are

rs b

ecause o

f

the lack o

f serv

ices.

Inad

eq

uate

qu

ality

co

ntr

ol

LA

s c

ontr

ol and a

ccre

dit b

ut no

cle

ar

norm

s a

nd d

efinitio

ns.

They f

und a

nd identify

min

imum

serv

ice s

tandard

s to a

ccre

dit a

ll

those p

rovid

ers

that re

spond to

these r

equirem

ents

.

Tra

inin

g-

part

ial -

yes for

pro

-

fessio

nal le

vel, B

ut fo

r lo

wer

116

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Dem

en

tia s

erv

ices -

part

ial

Resp

ite c

are

– n

one a

t hom

e

assis

tance, specia

lized

health c

entr

es for

Alz

-

heim

er’s d

isease, m

one-

tary

pro

vis

ions a

nd h

om

e

health c

are

)

level w

ork

ers

attem

pts

at R

e-

gio

nal le

vel, b

ut m

any u

nquali-

fied.

Luxem

bourg

H

om

e H

elp

and L

ocal co

ord

inati

on

cen

tres. Y

es. M

in. 3.5

hrs

per

week to

qualif

y for

OP

(dependent pers

on)

No p

rivate

serv

ices

Day C

are

cen

tres –

yes 7

centr

es r

un

by a

n N

GO

for

psycho-g

eriatr

ic c

ases

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e

Dem

en

tia s

erv

ices -

yes

Resp

ite c

are

– y

es (

3 w

ks p

er

year)

and fin

anced b

y d

ependency insura

nce.

2 F

oundations in c

harg

e

of aid

s a

nd s

erv

ices

within

fra

mew

ork

of de-

pendency insura

nce. O

ne

of th

eir c

oord

inato

rs v

isits

OP

and F

C a

fter

notifica-

tion fro

m U

nio

n o

f S

ick-

ness F

unds.

NG

Os r

unnin

g r

espite

care

serv

ices f

unded b

y

Min

istr

y.

All

needin

g h

elp

covere

d b

y

dependency insura

nce. P

ar-

tially

qualif

ied u

nder

SI be-

com

e e

ligib

le a

fter

1 y

ear.

Dependent O

P r

eceiv

es n

urs

-

ing a

llow

ance o

f 23.8

5 €

p.h

.

that can b

e u

sed to b

enefit

FC

. >

7 h

ours

care

p.w

. can

be u

sed b

y info

rmal care

r. 7

-

14 h

rs –

serv

ice n

etw

ork

s

must pro

vid

e h

alf the h

ours

.

14+

hours

per

week –

com

-

ple

tely

pro

vid

ed b

y h

elp

ser-

vic

es. D

ependent O

P r

e-

ceiv

es a

nnually d

ouble

the

am

ount of nurs

ing a

llow

ance

to fin

ance r

espite c

are

and

giv

e F

C tim

e f

or

recre

ation.

Tem

pora

ry s

tay in n

urs

ing

hom

es d

irectly fin

anced b

y

dependency insura

nce

Ad

eq

uate

qu

ality

co

ntr

ol

Pub-

lic e

valu

ation c

ente

r (C

EO

)

pro

vid

es e

stim

ate

s o

f needs f

or

care

and o

f benefits

needed

under

the d

ependency insur-

ance. C

EO

advis

es the U

nio

n

of S

ickness F

unds w

ho c

lassify

dependency, pay for

nurs

ing

serv

ices, negotiate

with s

er-

vic

es for

pro

vis

ion o

f nurs

ing

aid

s. F

urt

her

qualit

y d

evelo

p-

ment assura

nce u

nder

devel-

opm

ent.

Tra

inin

g.-

Adequate

Mostly

train

ed, pla

ns to e

xte

nd tra

inin

g

Malta

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres Y

es. 30 d

iffe

rent serv

ices to

main

tain

ing O

P in c

om

munity.

Serv

ices

inclu

de H

andym

an S

erv

ice,

Hom

e C

are

Help

, In

continence S

erv

ice, M

eals

on

Cases d

iscussed b

y In-

tern

al B

oard

of A

llocation

of

Serv

ice a

fter

applic

a-

tion a

nd m

edic

al re

port

;

on a

ccepta

nce g

oes to

Fre

e

Som

e p

rivate

agencie

s p

ro-

vid

e

hom

e a

nd n

urs

ing c

are

;

Ad

eq

uate

qu

ality

co

ntr

ol

In-

tern

al B

oard

of A

llocation o

f

Serv

ice

Tra

inin

g-

Good-

Mostly tra

ined

117

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Wheels

, T

ele

care

, etc

.

Waitin

g lis

ts

Day C

are

cen

tres –

5%

of O

P in 1

4

are

as

Ho

me h

ealt

h c

are

- C

om

pre

hensiv

e

inclu

din

g D

om

icili

ary

Nurs

ing

Dem

en

tia s

erv

ices –

in d

ay h

ospital,

plu

s a

dvic

e thru

’ N

GO

.

Resp

ite c

are

– s

om

e o

rganis

ed b

y

NG

O.

the a

rea s

uperv

isor

where

OP

liv

es;

allo

cation o

f

hours

of

serv

ice to O

P

made o

n b

asis

of

real

needs.

Many F

Cs u

sin

g H

H s

er-

vic

es f

eel it a

n a

dm

issio

n

of th

eir inabili

ty to liv

e u

p

to f

am

ily e

xpecta

tions,

leadin

g to a

n u

neasy

part

ners

hip

betw

een F

Cs

and f

orm

al serv

ice p

ro-

vid

ers

.

charg

es d

epend o

n the n

um

-

ber

of hours

serv

ice u

sed. B

ut

not easily a

fford

able

by e

very

fam

ily.

2 w

eeks tra

inin

g p

rior

to r

e-

cru

itm

ent. F

or

part

tim

e S

ocia

l

Assis

tants

446,

main

ly e

m-

plo

yed a

s H

om

e h

elp

s w

ith v

ery

sm

all

no. of

OP

as c

lients

with

PT

SA

s s

ele

cte

d fro

m the s

am

e

are

a o

f th

e b

eneficia

ries in h

er

care

.

Oth

ers

e.g

. M

em

orial

Dis

tric

t N

urs

ing A

ssocia

tion,

pro

fessio

nally tra

ined.

Neth

erlands

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres r

egio

nal in

tegra

ted n

eeds a

s-

sessm

ent agencie

s; only

1 in 5

chro

ni-

cally

ill

or

dis

able

d p

ers

ons u

ses p

ro-

fessio

nal assis

tance.

Day C

are

cen

tres 1

7%

uses c

are

at-

tendance f

acili

ties a

nd 1

0%

report

s that

the p

ers

on they c

are

for vis

it d

ay c

are

facili

ties o

r activity c

entr

es

Ho

me h

ealt

h c

are

- C

om

pre

hensiv

e

Dem

en

tia s

erv

ices –

yes,

som

e p

ilot

pro

jects

*

Resp

ite c

are

– y

es a

wid

e r

ange o

f

form

s a

t hom

e, day c

are

, by form

al

serv

ices a

nd N

GO

s

36%

of F

Cs d

o n

ot ar-

range f

orm

al hom

e c

are

because the c

are

receiv

-

ers

do n

ot w

ant str

angers

in their h

ouse F

Cs o

f

som

eone r

eceiv

ing form

al

hom

e c

are

als

o m

ore

often u

se s

upport

ser-

vic

es f

or

FC

s (

info

rma-

tion, advic

e a

nd e

mo-

tional support

serv

ices)

(48%

V29%

of th

e c

are

receiv

ers

without fo

rmal

hom

e c

are

).

Pro

fessio

nal H

H r

e-

str

icte

d to f

ew

tasks:

washin

g / b

ath

ing, dre

ss-

ing O

P, heavy h

ousehold

Needs a

ssessm

ent. P

ers

onal

care

budget so p

eople

buy

ow

n c

are

and m

any s

mall

private

hom

e c

are

org

anis

a-

tions a

re a

risin

g.

Yes o

ut of pocket paym

ents

–

53%

report

ed n

o d

ifficultie

s in

meeting these. O

P a

fter

as-

sessm

ent and if elig

ible

for

non-institu

tional care

, can a

sk

for

care

in c

ash o

r kin

d. A

nd

can u

se it to

pay F

C / k

in

Ad

eq

uate

qu

ality

co

ntr

ol.

Independent org

anis

ation m

oni-

tor

the larg

e h

om

e c

are

org

ani-

sations w

hic

h c

an r

eceiv

e a

quality

sig

n. O

rganis

ations w

ork

with c

are

pla

ns (

set up togeth

er

with p

atient)

; P

rivacy g

uara

n-

tee; C

lient / re

sid

ents

’ com

mit-

tees; In

dependent C

om

pla

ints

com

mitte

es.

Sm

all

private

hom

e c

are

or-

ganis

ations n

ot m

onitore

d a

nd

contr

olle

d b

y g

overn

ment

Tra

inin

g. A

dequate

Mostly

train

ed c

om

puls

ory

for

all

levels

except th

e low

est le

vel

118

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

tasks if th

ere

is n

o F

C o

r

when there

’s a

longsta

nd-

ing a

nd inte

nsiv

e c

are

situation a

nd tra

nsfe

r to

intr

am

ura

l care

is thre

at-

ened.

Norw

ay

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres L

A p

rovid

ed. 30%

eld

erly 7

5+

receiv

ed form

al hom

e h

elp

serv

ices.

30%

of th

e n

on-institu

tional popula

tion

67+

in n

eed o

f help

to s

hop a

nd c

lean.

5%

needed c

are

fro

m o

thers

or

could

hard

ly m

anage to d

ress o

r ta

ke c

are

of

their d

aily

pers

onal hygie

ne o

n their

ow

n.

Day C

are

cen

tres –

yes in n

early a

ll LA

are

as e

xcept very

sm

all

LA

s.

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e

inclu

din

g locally

availa

ble

sta

tuto

ry

rehabili

tation f

acili

ties

Dem

en

tia s

erv

ices –

80%

of

LA

s h

ave

specia

l dem

entia s

erv

ices, and incre

as-

ing n

o. to

support

FC

s.

Resp

ite c

are

- yes b

y L

As a

nd N

GO

s

LA

responsib

ility

; fa

mily

pro

vid

es less instr

um

enta

l

and p

ers

onal care

, but

tota

l le

vel of

help

(fr

om

fam

ily a

nd s

erv

ices)

in

Norw

ay is h

igher

than in

countr

ies w

ith m

ore

fam

ily

dom

inate

d c

are

syste

ms

But in

suffic

ient

public

serv

ices, and fam

ilies

supply

more

care

than

they fin

d r

easonable

.

Som

e F

Cs g

ive c

are

at

the c

ost of th

eir o

wn

health a

nd w

elfare

.

Part

co-p

aym

ent. L

A p

ays

All

in n

eed-

dis

abili

ty b

ased,

Indiv

idual entitlem

ent – e

ven

if F

C a

vaila

ble

.

Ad

eq

uate

qu

ality

co

ntr

ol.

Superv

isio

n legis

lation. LA

re-

sponsib

le.

Tra

inin

g-

Good, M

ost tr

ain

ed

Pola

nd

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres S

ocia

l care

at LA

, county

, re

-

gio

n. In

2002 L

A s

erv

ices w

ere

used b

y

81.2

thousand p

eople

2-3

tim

es p

er

week, 2 h

ours

serv

ices

Com

munity a

ssis

tance

inclu

des fin

ancia

l assis

-

tance (

main

ly p

erm

anent,

tem

pora

ry a

nd inte

ntional

benefits

) and s

erv

ices –

(e.g

. hom

e n

urs

ing s

er-

HH

dependent on the incom

e

and e

stim

ate

d n

eeds o

f all

the m

em

bers

of

the h

ouse-

hold

Fre

e.

But

co-p

aym

ents

for

Inad

eq

uate

qu

ality

co

ntr

ol.

Adm

inis

trative m

ain

ly.

NG

Os -

contr

ol is

restr

icte

d to

the fin

ancia

l aspects

and legal

basis

of

their a

ctivity a

nd fulfill

-

119

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Day C

are

cen

tres -

LA

s; N

os d

ecre

as-

ing.-

213

Dem

en

tia s

erv

ices –

not at hom

e

Ho

me h

ealt

h c

are

- inadequate

Resp

ite c

are

- no

vic

es, la

undry

serv

ices).

no s

ocia

l serv

ices m

ark

et,

whic

h w

ould

allo

w s

ocia

l

care

centr

es to b

uy s

er-

vic

es for

eld

erly a

nd d

is-

able

d fro

m N

GO

S o

r pri-

vate

Cos. 418.3

00

(160.7

00 1

pers

on

household

s)

household

s.

¾ in c

itie

s. N

.B. E

arlie

r

attem

pts

to inte

gra

te H

and S

S led to low

er

sta

tus o

f soc. C

are

work

-

ers

– c

urr

ent separa

tion

has incre

ased e

quality

medic

ines a

re h

eavy b

urd

en

for

FC

s,. P

lus p

aym

ents

to

attend p

rivate

clin

ics

ing their c

ontr

acts

.

Tra

inin

g. A

dequate

6,5

00 e

m-

plo

yees in S

ocia

l C

are

Centr

es

+ m

any v

olu

nte

ers

and e

mplo

y-

ees in N

GO

s +

11,0

00 S

ocia

l

Care

Centr

es e

mplo

yin

g 1

1,0

00

for

specia

lised c

are

.

Port

ugal

Hom

e H

elp

and L

ocal coord

ination

centr

es –

attem

pts

to inte

gra

te H

and

SS

.

Day C

are

centr

es g

row

th in n

os.

41,1

95 p

laces in 1

998

Ho

me h

ealt

h c

are

- inadequate

Dem

en

tia s

erv

ices -

no

Resp

ite c

are

- not in

hom

e, ra

re

S

mall

charg

e for

day c

are

Costs

for

usin

g s

om

e h

ealth

serv

ices a

t hom

e.

Inad

eq

uate

qu

ality

co

ntr

ol.

SW

specia

lists

undert

ake c

on-

trol and c

onsultations. C

ontr

ol

of econom

y o

f socia

l care

insti-

tutions b

ased o

n a

nnual (o

r

quart

erly)

activity r

eport

s. C

on-

trol over

NG

Os lim

ited to their

serv

ice c

ontr

acts

and the fin

an-

cia

l support

fro

m the m

inis

try.

Most of th

is c

ontr

ol is

restr

icte

d

to fin

ancia

l aspects

and legal

basis

of

the N

GO

’s a

ctivity.

Tra

inin

g –

inadequate

- som

e

attem

pts

to s

tart

wid

er

train

ing.

Slo

venia

H

om

e H

elp

and L

ocal co

ord

inati

on

cen

tres a

round 5

,000 p

eople

receiv

e

The c

urr

ent org

anis

a-

tional crisis

in h

ealth c

are

LA

vary

but socia

l hom

e a

s-

sis

tance s

ubsid

ised a

ppro

x.

Inad

eq

uate

qu

ality

co

ntr

ol.

120

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

public h

om

e h

elp

. by

52 c

entres

for so

cia

l

work

, 5 o

ld p

eople

’s h

om

es

and 3

priv

ate

pro

vid

ers

Day C

are

cen

tres 2

0 O

P h

om

es h

ad

centr

es; w

ith c

apacity for

aro

und 3

00

people

Ho

me h

ealt

h c

are

- inadequate

Dem

en

tia s

erv

ices –

NG

Os h

ave

sta

rted s

upport

serv

ices

Resp

ite c

are

– n

o

syste

m h

as s

ubsta

ntially

reduced n

urs

ing c

are

.

Physic

al conditio

n

70%

. T

his

serv

ice is n

ot

equally d

evelo

ped in a

ll m

u-

nic

ipalit

ies.

Num

bers

of

socia

l care

rs

declinin

g b

ecause o

f la

ck o

f

fundin

g for

LA

s.

Tra

inin

g –

mix

ed -

inadequate

.

qualif

ied h

om

e h

elp

sta

ff=

660;

Hom

e a

ssis

tants

can b

e e

x-

pert

s o

r pers

ons w

ho o

bta

ined

1 y

r tr

ain

ing for

hom

e s

ocia

l

care

rs, confirm

ed b

y the S

ocia

l

Cham

ber

of S

lovenia

. (1

year

part

tim

e-

168 s

chool hours

.

The p

ositio

n o

f a s

ocia

l care

r is

not a h

ealth p

rofe

ssio

n. T

rain

ed

nurs

e-c

are

rs

Spain

H

om

e H

elp

and L

ocal co

ord

inati

on

cen

tres S

harp

Incre

ase in d

em

and.

(75%

in 3

yrs

) 2.8

0%

of

65+

attended

by H

H s

erv

ice. 1 in 1

5 o

f th

ose a

ged

75+

. m

ain

ly w

om

en (

over

60%

); 5

3%

< 8

0 y

rs. A

v. 3.5

-4 h

ours

a w

eek p

er

pers

on, m

ean c

ost 9.5

€. p.h

.

1.4

8%

65+

get public

tele

-assis

tance

serv

ice, in

10+ o

f th

e 1

7 a

uto

nom

ous

com

munitie

s, in

cre

ase in d

em

and b

y

114.7

5%

.

70%

+ o

f H

H u

ndert

aken in p

rivate

secto

r.

Only

8%

of popula

tion w

ould

wis

h to b

e

attended o

nly

by the p

ublic

SS

and

12%

would

wis

h to b

e a

ttended b

y the

fam

ily a

nd the S

S togeth

er.

Day C

are

cen

tres 0

.11%

dependent

HH

care

pro

gra

mm

es in

Cata

lonia

in 9

0%

of th

e

prim

ary

care

centr

es,

more

than 7

5%

off

er

care

r tr

ain

ing a

nd a

lmost

69%

specific

“caring for

the c

are

r” p

rogra

mm

es.

Co-p

aym

ents

. H

om

e h

elp

is

expensiv

e-

the h

ourly s

erv

ice

costs

more

than 1

7 €

). W

here

OP

receiv

ed the f

undin

g (

or

the F

C)

they u

se m

oney for

irre

gula

r contr

acts

by the

hour,

without assum

ing the

corr

espondin

g labour

costs

,

so the m

unic

ipal m

oney c

on-

trib

ute

s to n

urt

uring the s

ub-

merg

ed e

conom

y d

aily

In a

day c

entr

e, th

ey m

ust

contr

ibute

25%

of th

eir p

en-

sio

n

Inad

eq

uate

qu

ality

co

ntr

ol.

LA

s r

esponsib

le b

ut doubtful

quality

poor

mechanis

ms o

f co-

ord

ination b

etw

een s

erv

ices;

genera

l scarc

ity o

f th

e s

erv

ice

and the h

igh levels

of co-

paym

ent.

Tra

inin

g –

inadequate

for

Pro

-

fessio

nals

- th

eir p

rofile

not al-

ways s

uitable

for

the w

ork

, es-

pecia

lly in s

uperv

isio

n a

nd

managem

ent; the s

carc

e inte

r-

est of th

e w

ork

ers

in jobs c

on-

cern

ing the h

ygie

ne a

nd p

er-

sonal attention to the O

P; th

e

genera

l poor

connection b

e-

tween the w

ork

ers

and the u

s-

ers

;

121

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

people

used a

serv

ice,

Ho

me h

ealt

h c

are

- inadequate

Dem

en

tia s

erv

ices -

no

Resp

ite c

are

- n

o

Sw

eden

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres L

A d

ecid

e s

erv

ice level, e

ligi-

bili

ty c

rite

ria a

nd r

ange o

f serv

ices.

Sin

gle

-entr

y s

yste

m; O

P h

elp

ed b

y L

A

where

he liv

es.

2003, 8%

65 y

ears

+ g

ot H

H. O

f 80+,

19%

got H

H i.e

. despite g

row

th in p

opu-

lation n

um

bers

HH

less b

ut conta

ct

hours

incre

ased s

uccessiv

ely

i.e

. fe

wer

pers

ons g

et m

ore

help

. 28%

get H

H in

the e

venin

gs a

nd n

ight.

Com

pre

hensiv

e L

A s

erv

ices e

.g. tr

ans-

port

ation s

erv

ices, fo

ot

care

, m

eals

on

wheels

, security

ala

rms, housin

g a

dap-

tations, handic

ap a

ids, etc

.

LA

s s

tart

ed F

C r

esourc

e c

entr

es o

ffer-

ing tra

inin

g, counselli

ng, support

gro

ups, re

spite c

are

, and o

ther

info

rma-

tion a

nd r

esourc

es f

or

fam

ily c

are

giv

ers

Day C

are

cen

tres -

Yes p

rogra

ms for

dis

able

d f

am

ily m

em

ber

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e.

2.7

% 6

5+

get hom

e n

urs

ing c

are

Dem

en

tia s

erv

ices -

Yes

Need a

ssessm

ent by L

A

care

manager.

In s

om

e

LA

s inte

rdis

cip

linary

care

pla

nnin

g team

s for

as-

sessm

ent and c

o-

ord

ination o

f eld

erc

are

serv

ices f

requent, e

spe-

cia

lly c

oncern

ing a

per-

manent m

ove t

o institu

-

tional care

. 4%

of all

OP

with H

H r

eceiv

ed m

ore

than 1

20 h

ours

p.m

..

Co-p

aym

ent but th

ere

is a

cap o

n h

ow

much the u

ser

pays, to

ensure

they h

ave

incom

e left for

their o

wn e

x-

penses. In

more

than h

alf o

f

all

munic

ipalit

ies,

care

man-

agem

ent is

based o

n a

pur-

chaser

– p

rovid

er m

odel.

Private

, out of

pocket paid

health c

are

is e

xtr

em

ely

un-

usual

Ad

eq

uate

qu

ality

co

ntr

ol.

LA

monitors

plu

s s

uperv

isio

n b

y

the N

ational B

oard

of H

ealth

and W

elfare

(fo

cusin

g h

ealth

care

issues a

nd b

ased o

n the

Health C

are

Act)

and the

county

Adm

inis

trative B

oard

(focusin

g s

ocia

l serv

ice issues

and b

ased o

n the S

ocia

l S

er-

vic

es A

ct)

.

Tra

inin

g. G

ood

192 0

00 p

ers

ons (

hom

e h

elp

-

ers

/ n

urs

es a

ids)

were

em

-

plo

yed in the h

om

e h

elp

ser-

vic

es. 25%

were

full-

tim

e e

m-

plo

yed, nearly 6

0 p

er

cent

work

ed p

art

-tim

e a

nd the r

est

were

on a

n h

ourly b

asis

em

-

plo

ym

ent.

122

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

Resp

ite c

are

- yes

Sw

itzerland

Ho

me H

elp

and L

ocal co

ord

inati

on

cen

tres –

larg

e v

ariations b

etw

een

canto

ns; som

e p

rovid

e H

H o

thers

do

not.

Day C

are

cen

tres –

som

e, unequal

covera

ge, attached to h

ospitals

or

run

by N

GO

s e

.g.

Spitex

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e.

Palli

ative c

are

at hom

e a

lso a

vailable

Dem

en

tia s

erv

ices –

90,0

00 p

ers

ons

affecte

d b

y A

lzheim

er

Resp

ite c

are

- very

little.

Cannot genera

lize r

esults

as c

anto

ns im

ple

ment

very

diffe

rent polic

ies in H

& S

S

a third o

f th

e e

lderly d

e-

cla

re they d

on’t w

ant

hom

e c

are

serv

ices b

e-

cause they d

on’t w

ant

fore

igners

at hom

e.

Costs

of

hom

e n

urs

ing n

ot

fully

covere

d b

y H

I

The e

conom

ic v

alu

e o

f F

C

work

has b

een c

alc

ula

ted to

reach b

etw

een 1

0 a

nd 1

2

bill

ions o

f S

wis

s F

rancs, ex-

ceedin

g the c

um

ula

ted

spendin

g o

f both

the H

C s

er-

vic

es a

nd the O

P h

om

e o

f

Sw

itzerland

Ad

eq

uate

qu

ality

co

ntr

ol.

Tra

inin

g-

only

for

health p

er-

sonnel. Inadequate

for

oth

ers

.

UK

H

om

e H

elp

and L

ocal co

ord

inati

on

cen

tres. LA

s n

ow

giv

e m

ore

inte

nsiv

e

serv

ices to less u

sers

. 2002 a

v. conta

ct

hours

for

each o

f th

e s

upport

ed

366,8

00 h

ousehold

s =

8.1

hours

. 41%

of th

ose n

eedin

g c

are

get vis

its fro

m

H&

SS

or volu

nte

ers

64%

pro

vid

ed b

y the independent sec-

tors

, up fro

m 4

2%

5 y

ears

ago

Day C

are

cen

tres 6

5-7

4 y

ear

age

gro

up, 32%

of

care

d-f

or

people

attend

som

e form

of

daily

clu

b o

r day c

are

/

hospital, w

ith the fig

ure

bein

g 2

9%

in

those a

ged 8

5 a

nd o

ver

Ho

me h

ealt

h c

are

- c

om

pre

hensiv

e

Wheth

er

the h

ousehold

was involv

ed in h

eavy

care

did

not add s

ignifi-

cantly t

o the lik

elih

ood o

f

usin

g s

erv

ices.

(41%

) of care

d-f

or

peo-

ple

(of all

age g

roups)

receiv

e v

isits fro

m h

ealth,

socia

l or

volu

nta

ry s

er-

vic

es. V

isits low

er

if liv

ed

with F

C c

are

r (2

3%

) V

in

anoth

er

household

(50)

e.g

. hom

e h

elp

/ m

eals

on

wheels

(9%

/ 3

1%

).

People

liv

ing in the s

am

e

Aft

er

assessm

ent

by S

ocia

l

serv

ices-

means a

nd n

eeds

teste

d.

Ad

eq

uate

qu

ality

co

ntr

ol.

Socia

l serv

ices -

lin

e m

anage-

ment and r

eport

ing s

yste

ms

back thro

ugh to a

n E

xecutive

Directo

r.

Exte

rnal pro

vid

ers

such a

s v

ol-

unta

ry o

rganis

ations o

r com

-

merc

ial secto

rs a

re m

anaged

by their o

wn m

anagers

/ o

wn-

ers

/ c

om

mitte

e / b

oard

. N

a-

tional C

are

Sta

ndard

s C

om

mis

-

sio

n g

uara

nte

es q

uality

.

All

purc

hased h

om

e c

are

ser-

vic

es a

re d

eliv

ere

d u

nder

con-

tract w

ith a

legal F

orm

of

123

Co

un

trie

s

Availab

ilit

y o

f H

om

e B

ased

serv

ices

Hom

e H

elp

and L

ocal coord

ination

centr

es; D

ay C

are

centr

es; P

ublic s

ec-

tor;

Hom

e H

ealth c

are

– D

em

entia s

er-

vic

es; R

espite c

are

in the h

om

e

Ad

dit

ion

al co

mm

en

ts

Co

sts

of

usin

g s

erv

ice c

are

Aff

ord

ab

ilit

y

Qu

ality

& c

on

tro

l o

f serv

ice –

ISO

.

Tra

inin

g o

f W

ork

ers

with c

hiropody a

nd H

V o

r dis

tric

t nurs

e

bein

g m

ost popula

r.

Dem

en

tia s

erv

ices –

Alz

heim

er

Assoc.

has 2

5,0

00 m

em

bers

,300 b

ranches a

nd

support

gro

ups; giv

es info

rmation a

nd

education for

people

with d

em

entia,

FC

s. &

pro

fessio

nals

. ru

ns q

uality

day

and h

om

e c

are

,

Resp

ite c

are

- yes, w

as the e

ssential

serv

ice in s

upport

ing F

Cs b

ut fu

ndin

g

no longer

guara

nte

ed for

this

purp

ose.

household

as the c

are

r

are

less lik

ely

to r

eceiv

e

vis

its fro

m h

ealth p

racti-

tioners

(15%

/ 3

0%

Agre

em

ent and a

deta

iled S

er-

vic

e S

pecific

ation. T

heses a

re

subje

ct to

quart

erly m

onitoring,

Annual S

erv

ices R

evie

ws a

nd

independent serv

ice u

ser

sur-

veys r

un b

y S

SD

Contr

acts

Unit. IS

Os.

Tra

inin

g –

adequate

124

5.9

A

nn

ex 9

– M

atr

ix:

Care

of

de

pe

nd

en

t o

lder

Pe

op

le –

cu

rre

nt

an

d f

utu

re S

up

ply

of

form

al

an

d i

n-

form

al

Care

Giv

ers

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

Austr

ia

40%

work

and c

are

.

above a

v. F

or

those w

ith low

sta

tus jobs

55%

liv

ed w

ith o

r adja

cent to

OP

. 2 / 3

of dependent O

P

get F

C

Only

0.5

% o

f A

ustr

ians lis

t

no o

ne u

pon w

hom

they c

an

rely

in m

inor

cases o

f need.

In s

erious c

ases o

f need a

s

well there

are

few

people

(1.7

%)

who c

onsid

er

them

-

selv

es w

ithout any s

upport

from

rela

tives o

r fr

iends.

Better

educate

d

+ those w

ith

better

jobs less

willin

g to c

are

.

Low

wage s

ec-

tor-

7.5

-8 p

r

hour.

Pro

ble

ms I

gettin

g h

elp

at

weekends a

nd

nig

ht.

Short

age o

f

hom

e h

ealth

nurs

es.

Yes-

re-

privatization o

f

care

.

Yes.

Young m

en

can u

ndert

ake

care

inste

ad

of m

ilita

ry

serv

ice

Larg

e g

rey L

M o

f

mig

rants

as c

are

and d

om

estic

work

ers

fro

m E

Euro

pe. E

.g.

Czech R

epublic

or

Hungary

. E

s-

tim

ate

d c

osts

for

a 2

4-h

our

in-

hom

e s

erv

ice a

re

aro

und 1

,400 €

p.m

..

1.

Yes –

part

ly

paid

for-

done

by N

GO

s a

nd

LA

2.

Yes –

no n

a-

tional re

gula

-

tions o

r sta

n-

dard

s

3.

Yes-

som

e b

ut

many n

ot

train

ed

Belg

ium

5.8

9%

of

Belg

ians 1

6+

were

caring w

ithout pay for

som

e-

one w

ho is ill,

dependent or

eld

erly.2

/ 3

care

d for

by

fam

ily –

no c

hange

Maj aged 4

4-7

6, 69.3

3%

fem

ale

. 66.3

6%

marr

ied.

More

lik

ely

than n

on c

are

rs

to b

e p

ensio

ners

, house-

wiv

es o

r unem

plo

yed. O

f

those in p

aid

work

, 30%

in

Gre

ate

r m

obili

ty

and less F

C

available

makes

futu

re c

are

diffi-

cult.

Belg

ian L

M-

53.3

7%

men,

31.9

2%

wom

en

aged 5

0-6

5 a

c-

tive in L

M

Dem

and f

or

hom

e s

erv

ices

larg

er

than s

up-

ply

Difficultie

s in

findin

g c

ert

ifie

s

nurs

es

Good r

esid

ential

care

.

Govt. a

ttem

pting

No info

rmal

unre

gis

tere

d

care

rs.

Na d

ata

Yes –

sit in

No d

ata

1.

Yes –

fro

m

subsid

ized

care

rs’ gro

ups

2.

Yes

3.

Yes-

sit in

serv

ices.

125

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

pt / tim

e. 39.2

6%

15 h

rs p

er

week;

4%

sto

pped t

em

p.

work

because o

f caring. A

v

17.5

hrs

care

per

week

(1 >

99)

59%

liv

e in s

am

e

household

. 14.8

9%

hus-

bands, 46.8

2 p

are

nts

,

14.3

3%

in law

s, oth

er

fam

ily

care

d for

16.9

9%

non fam

ily

= 1

3.3

1%

Bre

akdow

n b

y those n

eedin

g

care

and a

ge.

2 / 3

of care

from

fam

ilies b

ut

OP

thin

k f

am

i-

lies less w

illin

g

to c

are

.

to im

pro

ve w

ork

-

ing c

onditio

ns

and w

ages.

11,0

00 s

elf e

m-

plo

yed n

urs

es –

30%

not ft / tim

e

in s

elf e

mpl. b

ut

work

in h

ospitals

Bulg

aria

20%

unem

plo

ym

ent and 1

mill

ion é

mig

rés leaves m

any

OP

without F

Cs

Unknow

n

Inadequate

,

bad, irre

gula

r

pay. B

ut a larg

e

supply

of quali-

fied p

ers

onnel.

Yes-

gro

wth

in

hire o

f private

care

rs (

thro

ugh

mig

rant re

mit-

tances)

Yes.

- 1.

–

2.

Yes

3.

Yes f

or volu

n-

teers

Czech

Republic

Childre

n (

53%

), s

pouse

(21%

), friends (

16%

) and

rela

tives (

10%

). F

Cs-

64%

wom

en 3

6%

of m

en. 80%

of

care

pro

vid

ed a

t hom

e.

Appro

x. 100 0

00 s

enio

rs

need a

ssis

tance w

ith b

asic

AD

L, about 300 0

00 s

enio

rs

need a

ssis

tance w

ith IA

DL.-

appro

x. 400-

500 0

00 F

Cs.

The a

vera

ge tim

e p

eriod o

f

this

type o

f care

is 4

-5 y

ears

.

Wom

en o

f LM

age a

re the

Hig

h r

ate

s o

f

em

plo

ym

ent

am

ongst w

om

en

till

55.

Even in r

egio

ns

with a

hig

h u

n-

em

plo

ym

ent ra

te

there

may b

e

vacancie

s in

socia

l care

. T

he

level of

incom

e

receiv

ed b

y

caring p

rofe

s-

sio

nals

is s

o low

that m

any p

eo-

ple

pre

fer

to s

tay

rath

er

unem

-

No d

ata

but

som

e f

rom

ex

Sovie

t U

nio

n in

non r

egis

tere

d

dom

estic w

ork

–

126

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

most fr

equent

care

giv

ers

.

80%

are

em

plo

yed.

plo

yed than to

work

with o

lder

people

.

Denm

ark

M

ax. 55%

OP

get help

with

cert

ain

tasks w

ith p

rim

ary

pro

vid

ers

bein

g s

pouses a

nd

childre

n –

but no a

ccura

te

data

– M

ost help

is for

house, tr

ansport

.

fem

ale

labour

forc

e p

art

icip

a-

tion r

ate

s o

ne o

f

hig

hest A

ged

44-5

0 e

xpect to

spend m

ore

tim

e

with F

C than

old

er

genera

-

tions.

100,0

00 f

ull-

tim

e

em

plo

yees.

2.0

01 to 2

002,

the%

gro

wth

in

the n

um

ber

of

full-

tim

e e

m-

plo

yees in the

care

secto

r fo

r

old

er

people

at

4.4

per

cent w

as

more

than thre

e

tim

es the g

row

th

in the n

um

ber

of

old

er

people

aged 8

0 y

ears

and o

ver

in that

year

(1.4

per

cent)

.

Tra

inin

g a

ims to

addre

ss r

ecru

it-

ment pro

ble

ms

in the c

are

(fo

r

old

er

people

)

secto

r. 9

0%

fem

ale

- attem

pts

to a

ttra

ct m

en.

Sam

e a

s p

ublic

Yes

No d

ata

– lim

ited

use o

f private

work

s b

ut

120,0

00 f

ore

ign

work

ers

of

whom

20 p

er

cent w

ere

from

centr

al and

Easte

rn E

uro

-

pean c

ountr

ies

and 2

4 p

er

cent

were

fro

m A

sia

1.

–

2.

Yes-

basic

train

ing s

yste

m

in p

hases, in

-

cre

ase m

otiva-

tion for

furt

her

train

ing

14-2

0 m

onth

s

for

dom

estic

work

, and o

ver

95%

of th

ose

work

ing w

ith

old

er

people

have this

level

of tr

ain

ing.

Tra

inees r

e-

ceiv

e a

sala

ry

as a

tra

ined

work

ing c

are

work

er.

3.

–

127

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

Fin

land

43%

spouses, 22%

childre

n,

22%

pare

nts

(all k

inds o

f

FC

s)

30%

aged 1

8-4

9

33%

40-6

4

39%

65+

Men 2

5%

of F

Cs

More

sin

gle

pers

on h

ouse-

hold

s o

f 75 +

years

Huge incre

ase

in n

o o

f O

lder

wom

en w

ork

ing

and a

ttem

pts

to

incre

ase this

furt

her

Short

ages f

ore

-

seen

Incre

ase in n

o.

of m

en c

are

rs

Short

age o

f

work

ing a

ge

people

.

Pro

ble

m o

f re

-

tention low

sala

-

ries a

nd e

mi-

gra

te to w

ork

els

ew

here

.

Incre

ase o

f 25%

in p

ers

onnel

Yes e

sp. pen-

sio

ners

. B

ut

NG

Os n

eed

volu

nte

ers

.

Info

rmal care

accounts

for

only

1%

of

care

.

Low

availabili

ty

1.

yes b

y C

are

rs

associa

tions

2.

yes

3. F

innis

h R

ed

Cro

ss a

nd

Churc

h

Fra

nce

Nos incre

ased w

ith d

eclin

e

of old

er

wom

en’s

LM

part

ici-

pation. 3,2

% in r

esid

ential

hom

es, 0,6

% p

rofe

ss h

elp

only

. Low

LM

part

icip

ation o

f

gro

up 5

5 to 6

4 y

ears

Develo

pin

g

main

ly thru

NG

Os

Short

age o

f

nurs

es in h

ospi-

tals

. N

o s

hort

-

age in the o

ther

secto

rs (

except

of qualif

ied

hom

e-h

elp

ers

,

but m

any s

er-

vic

es e

asily

recru

it u

nskill

ed

hom

e-h

elp

ers

).

Few

Larg

e c

ivil

org

s –

NG

Os

pro

vid

ing

many v

olu

n-

teers

.

Neig

hbours

very

im

port

ant

Yes b

ut no d

ata

1.

Yes

2. Y

es b

ut often

not ta

ken u

p

3.

Yes f

or volu

n-

teers

Germ

any

60%

55+

Unem

plo

yed / u

nskill

ed.

Civ

il serv

ants

, self e

mplo

yed

More

educate

d

in ft

em

plo

y-

ment. D

eclin

e in

norm

s o

n F

C.

Serv

ice led, not

needs led.

Short

ages, a lot

of overt

ime.

Yes –

much n

on

decla

red. Larg

e

variety

to m

eet

needs o

f house-

Yes.

Volu

n-

teers

com

-

pensate

d.

Est. 5

0,0

00 m

i-

gra

nts

as c

are

work

ers

, M

any

paid

thru

LT

CI

1. s

om

e -

fre

e

2. Y

es-

in a

ll

are

as

128

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

and s

ala

ried c

om

bin

e w

ork

with F

C,

M / c

accept re

sid

ential care

.

FC

s c

aring for

OP

not suff

er-

ing fro

m d

em

entia s

ignifi-

cantly m

ore

engaged in L

M

(30,9

%)

than those takin

g

care

of O

P s

uff

ering fro

m

dem

entia (

25,3

%).

LT

CI help

ed

wom

en r

etr

eat

from

FC

.

P25 –

diffe

r-

ences in a

tti-

tudes to F

C b

y

age g

roups.

(despite h

igh

unem

plo

ym

ent

rate

s)

Dra

matic p

rob-

lem

s, in

ade-

quate

pro

vis

ion,

20,0

00 n

ew

jobs

would

have to

be c

reate

d in

LT

C t

o fill

all

exis

ting a

nd n

ew

jobs a

nd to r

e-

duce the a

mount

of overt

ime.

27,0

00 u

nem

-

plo

yed. geriatr

ic

care

pro

fessio

n-

als

at F

edera

l

Labour

Offic

e;

quality

of appli-

cants

qualif

ica-

tions a

lso d

ete

-

riora

ting

hold

s. 1994 4

mill

. H

ousehold

s

em

plo

yed d

o-

mestic h

elp

but m

any s

till

illegal. P

rivate

household

s 2

nd

larg

est em

plo

yer

in g

rey L

M. W

ork

perm

its n

ow

perm

itte

d, un-

know

n take u

p

and a

void

ance

because o

f

hig

her

costs

for

soc. In

sura

nce.

3. Y

es

Gre

ece

Estim

ate

d 6

36,1

14 a

ged 6

0+

need p

art

or

full

tim

e c

are

.

No d

ata

on n

um

bers

of F

Cs.

Men incre

asin

gly

involv

ed a

s

FC

s

29%

of all

household

s c

are

for

som

eone w

ho is d

epend-

Attem

pts

to in-

cre

ase L

F p

ar-

ticip

ation o

f

wom

en-

but

curr

ently low

especia

lly for

old

er

wom

en

Low

pre

stige o

f

job a

nd g

ener-

ally low

pay

make m

any

decid

e that it is

not a d

esirable

labour

choic

e.

Som

e s

igns o

f

private

serv

ices

of nurs

es s

tart

-

ing for

the b

etter

off

.

Ort

hodox

Churc

h a

nd

oth

er

churc

hes r

un

volu

nta

ry

serv

ices that

inclu

de F

C

Yes-

many w

ork

-

ers

, 13%

esti-

mate

d in d

om

es-

tic w

ork

and

many o

f th

ese in

care

for

OP

-

rough e

stim

ate

1.

som

e

2.

som

e

3.

som

e

129

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

ent; this

inclu

des c

hild

ren,

the d

ependent dis

able

d a

s

well a

s d

ependent old

er

people

.

(45+

) plu

s h

igh

unem

plo

ym

ent.

Hig

h n

um

bers

cohabitin

g w

ith

OP

– a

s s

pouse

and c

hild, but

decline w

ith

incre

asin

g in-

com

e /

educa-

tion.

Overa

ll tr

adi-

tional lo

w n

um

-

bers

ente

ring

nurs

ing.

support

. O

r-

thodox h

ad

23,0

00 g

ivin

g

severa

l hours

of volu

nta

ry

work

per

year.

But lo

w levels

overa

ll of

volu

nta

rism

.

that

6.4

% o

f

Gre

ek h

ouse-

hold

s e

mplo

yed

som

eone to h

elp

OP

.

Hungary

O

f all

OP

- 11.3

% r

elied o

n

daughte

rs a

nd 8

.7%

sons.

Bro

thers

declined to 1

.5%

,

slight in

cre

ase in h

elp

by

sis

ters

4.1

% Incre

ase in n

os

of sons a

s c

are

rs b

ecause o

f

late

marr

iage.

Rura

l are

as a

doption o

f

young p

eople

(19.2

% O

P

rely

on friends)

and (

34.4

%)

neig

hbours

as F

Cs. S

pouse,

Ds a

nd s

ons m

ost im

port

FC

s.

Low

/ d

eclinin

g

LM

activity r

ate

for

wom

en –

huge incre

ase in

availabili

ty. Liv

e

less w

ith O

P.

Very

little p

t /

tim

e w

ork

No c

hanges in

am

ount of F

c

giv

en t

o O

P.

But

num

bers

of

po-

tential F

Cs

ste

adily d

eclines

for

OP

.

Inadequate

nurs

ing.

Short

ages o

f

work

ers

in p

ublic

secto

r, low

wages,

low

sta

tus. M

ain

ly

wom

en.

Hard

ly a

ny b

e-

cause o

f eco-

nom

ic s

ituation

of

OP

.

Availa

ble

and

as e

mplo

yees,

at lo

wer

wages than

public s

ecto

r.

Import

ant in

pro

vid

ing

serv

ices to

OP

.

Men a

s a

lter-

native to m

ili-

tary

serv

ice

Huge incre

ase

in c

ivil

org

ani-

zations-

70,0

00 N

GO

s,

13%

in h

ealth

and c

are

field

s.

No

1.

–

2. M

ost

have

train

ing.

Som

e innova-

tive t

rain

ing

from

NG

Os f

or

young p

eople

to b

ecom

e

care

rs. 90%

of

em

plo

yees o

f

NG

Os a

re

train

ed c

om

-

pare

d to 6

0–

70%

for

the

public s

ecto

r.

3. y

es-

som

e -

import

ant

Irela

nd

Huge incre

ase in L

M p

art

ici-

Dem

ogra

phic

4.6

% in n

urs

ing

Larg

e p

rivate

T

he v

olu

nta

ry

No s

tatistical

1.

Yes –

13 w

eek

130

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

pation o

f w

om

en to 5

0%

(2003)

and h

ighest ra

te o

f

incre

ase f

or

those a

ged 4

5-

64 y

rs. 1 / 3

work

ed p

art

tim

e.

38.6

% m

ale

, 61.4

%

fem

ale

(C

ensus 2

002)

Half F

C p

rovid

e c

are

for

pare

nts

/ in-law

; 1 in 4

for

spouse; 1in

5 a

noth

er

rela

-

tive.

5-6

% o

f adults a

s c

are

rs-

154,0

00-1

85,0

00 o

f w

hic

h

133,0

00 a

nd 1

59,0

00 a

dults

of w

ork

ing a

ge

In C

are

rs C

linic

s 4

3%

were

60+

22%

7-=

80

25%

men

bulg

e o

f people

aged 6

5+

will

be

in 2

040s.

Wom

en c

are

rs

have m

arg

inally

low

er

rate

s o

f

em

plo

ym

ent

(47.4

%)

as

wom

en n

ot car-

ing (

50.9

%).

Incre

ase in n

o.

of m

en c

are

rs.

Wom

en m

ay b

e

less w

illin

g to

care

in futu

re

with f

orm

al em

-

plo

ym

ent risin

g,

and g

reate

r

dem

and f

or

support

fro

m

govt., public

serv

ice. S

till

majo

rity

of

wom

en F

Cs n

ot

in p

aid

em

plo

y-

ment

No r

ela

tion b

e-

tween h

igher

education a

nd

hours

of

caring.

hom

e c

are

.

Gro

win

g d

e-

mand

Serv

ices g

ener-

ally u

nder-

funded a

nd u

n-

der-

sta

ffed e

s-

pecia

lly: nurs

ing

thera

pie

s c

hi-

ropody

respite c

om

mu-

nity / h

om

e-

based s

erv

ices

hom

e h

elp

Poor

pay a

nd

work

ing c

ondi-

tions f

or

hom

e

help

s a

nd n

o

pro

motion. H

H

not

attra

ctive t

o

work

with o

lder

people

. S

om

e

sta

ff s

hort

ages

secto

r – h

ospi-

tal, n

urs

ing

hom

e, th

era

pie

s,

hom

e n

urs

ing

am

ong o

thers

.

48%

of th

e

popula

tion a

vail

of care

as p

ri-

vate

patients

in

public h

ospitals

or

in p

rivate

hospitals

. S

om

e

sta

ff s

hort

ages

in p

rivate

secto

r

especia

lly n

urs

-

ing

secto

r is

a

sig

nific

ant

pro

vid

er

of

serv

ices in

com

munity,

prim

ary

, hos-

pital, long-s

tay

and r

espite

care

. T

he

HS

E f

unds

volu

nta

ry

org

anis

ations

to p

rovid

e

serv

ices it

cannot pro

-

vid

e its

elf.

Volu

nta

ry

org

anis

ations

are

som

e-

tim

es p

ro-

vid

ed thro

ugh

the r

elig

ious

org

anis

ations,

but m

any a

re

independent

and c

om

mu-

nity-b

ased.

data

availa

ble

,

anecdota

l evi-

dence o

f som

e

mig

rant w

om

en

work

ing in d

o-

mestic a

nd c

are

secto

rs

modula

r skill

s

train

ing in 1

7

locations

2.

Tra

inin

g p

ro-

vid

ed b

y v

olu

n-

tary

org

anis

a-

tions f

or

hom

e

care

pers

on-

nel. W

hile r

ec-

om

mendations

have b

een

made r

egard

-

ing c

ert

ific

ation

of hom

e h

elp

s,

these r

ecom

-

mendations

have n

ot yet

been im

ple

-

mente

d b

y

Govern

ment.

3.

–

131

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

Italy

75-8

0%

of eld

erly c

are

is

carr

ied o

ut in

the info

rmal

netw

ork

of

an e

xte

nded fam

-

ily Incre

ase in F

C a

ge (

61

men, 60 w

om

en),

in n

os o

f

sons c

aring b

ut 2 / 3

wom

en

are

the F

Cs r

isin

g to 8

1%

for

heavy c

are

. 10%

are

over

80

years

Decline in m

ulti-genera

tion

household

s.

Care

rs h

ave m

ore

incom

e

than n

on c

are

rs. 60%

not

happy w

ith e

conom

ic s

itua-

tion. W

ork

ing w

om

en g

ive

less t

ime t

o c

are

. C

are

rs

have a

hig

her

education

level th

an n

on c

are

rs

Decline b

ecause

of in

cre

ase in

num

bers

of

wom

en in L

M

(20%

in 1

970 to

36%

IN

2003)

and incre

ase in

retire

ment age.

Local la

bour

supply

of hom

e

care

work

ers

for

OP

much low

er

than the d

e-

mand, sin

ce

local people

unw

illin

g to a

c-

cept a job that is

consid

ere

d tirin

g

and w

earing.

Tre

nd o

f S

tate

in

pro

vid

ing m

ore

cash n

ot ser-

vic

es. (u

sed b

y

care

rs to p

ur-

chase in p

rivate

serv

ices)

756,4

46 c

are

allow

ances w

ere

gra

nte

d to Ita

lian

citiz

ens o

f over

65 y

ears

of

age,

for

a t

ota

l cost

of

3,6

22,3

22,9

40 €

600-7

00,0

00,

50%

of to

tal

regis

tere

d w

ork

-

ers

are

fore

ign-

ers

. U

sed f

or

hom

e a

nd n

ight

care

, used in

private

hospi-

tals

. A

nd p

ublic

for

nig

ht care

“badanti”

(pri-

vate

ly p

aid

car-

ers

A n

um

ber

of

self h

elp

and

advocacy

gro

ups a

nd

active in s

om

e

are

as.

(ww

w.a

imaro

ma.it)

Attitude o

f lo

cal

work

forc

e h

as

incre

ased r

e-

cours

e to f

ore

ign

work

ers

who, at

least during the

firs

t period o

f

their s

tay in Ita

ly,

more

ready to

work

in o

ccupa-

tional secto

rs

that are

chara

c-

terized b

y g

reat

uncert

ain

ty a

nd

are

consid

ere

d

menia

l by the

locals

Thus a

larg

e a

nd g

row

-

ing n

um

ber;

many ille

gal.

Incre

asin

g e

ffort

s

to legalise them

.

1. –

2. Y

es f

or

those

em

plo

yed in

form

al in

stitu

-

tions a

nd s

er-

vic

es.

But fe

w

mig

rants

–

94%

have

train

ing

(though o

ften

educate

d

hig

hly

. 36%

of

fam

ilies’ per-

sonal assis

-

tants

(36%

)

and 1

6%

of

em

plo

yed

hom

e c

are

work

ers

have

none o

r a just

suffic

ient un-

ders

tandin

g o

f

the Ita

lian lan-

guage

3.

Luxem

-

bourg

465 F

Cs r

ecord

ed a

s g

ivin

g

help

to fam

ily m

em

ber-

94.2

% f

em

ale

. – m

ean a

ge

43.7

- M

ostly s

erv

ing p

eople

aged 7

0+

(80%

)

O

vera

ll no c

ur-

rent short

ages

sin

ce w

ages a

re

hig

h a

nd a

ttra

ct

work

ers

fro

m

Som

e b

egin

nin

g

to e

merg

e

M

ore

than h

alf in

health a

nd s

ocia

l

serv

ices a

re o

f

fore

ign o

rigin

(main

ly o

ther

EU

–

132

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

neig

hbouring

countr

ies; but

long term

fear

of

short

ages in

nurs

ing p

ers

on-

nel evid

enced

by d

eclin

e in

enro

lment in

Nurs

ing S

chool.

countr

ies)

Malta

Of

the 2

59 f

am

ily c

are

rs

benefiting f

rom

the G

overn

-

ment’s C

are

r’s P

ensio

n 5

9%

cent

were

fem

ale

s a

s c

om

-

pare

d to 4

1%

men. A

noth

er

stu

dy h

ad 7

4%

of F

Cs fe-

male

.

74.5

% o

f in

terv

iew

ed F

Cs

were

child F

Cs.

78.7

% r

espondents

in o

ne

researc

h c

ohabitant w

ith O

P.

18.1

per

cent liv

ed b

etw

een

1-2

kilo

metr

es a

way.

Low

(31%

) LM

part

icip

ation

of w

om

en 1

6-6

4.

Som

e e

vid

ence o

f in

cre

asin

g

male

part

icip

ation in F

C

Decline b

ecause

of in

cre

ases in

num

bers

of

OP

,

resid

ential m

o-

bili

ty a

nd in-

cre

asin

g L

M

part

icip

ation o

f

wom

en.

But m

ore

OP

involv

ed in c

are

of gra

ndchild

ren

Decline in n

um

-

bers

ente

ring

religio

us v

oca-

tions (

nuns)

has

led to incre

asin

g

reliance o

n p

aid

lay w

ork

ers

.

How

ever

no

difficultie

s in

recru

itm

ent fo

r

part

tim

e c

are

work

ers

.

How

ever

no

difficultie

s in

recru

itm

ent fo

r

part

tim

e c

are

work

ers

.

A lot

of

work

thru

Churc

h

with e

lderly

Good

Neig

hbour

Schem

e;

So-

cia

l C

lubs;

Self-H

ealth

Care

; A

ware

-

ness P

ro-

gra

mm

es

in S

chools

No

1.

Yes

2.

Yes-

availa

ble

but

not

com

-

puls

ory

in p

ri-

vate

secto

r.

3.

The v

olu

nte

ers

of each g

roup,

85 p

er

cent of

whom

are

them

selv

es

eld

erly, re

ceiv

e

train

ing g

iven

by C

arita

s s

o-

cia

l w

ork

ers

at

the h

eadquar-

ters

. T

hey a

lso

attend r

e-

fresher

sem

i-

nars

org

anis

ed

every

3

month

s.

133

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

Neth

er-

lands

no n

ation-w

ide r

egis

tration o

f

FC

s.

3,7

mill

ion –

29%

of D

utc

h

popula

tion o

ver

18 y

ears

–

pro

vid

ed c

are

for

a r

ela

tive,

frie

nd o

r neig

hbour

in n

eed

in 2

001. M

ore

than tw

o m

il-

lion p

eople

took c

are

of

som

eone 6

4 +

years

.

400,0

00 (

18.8

%)

inte

nse a

nd

long term

.

Age b

reakdow

n o

f F

c s

how

more

aged 5

4%

= a

ged 4

5-

64

The p

refe

rence for

help

fro

m

rela

tives / a

cquain

tances h

as

declined e

specia

lly a

mong

hig

her

educate

d p

eople

.

They m

ore

often c

all

for

as-

sis

tance f

rom

private

care

-

giv

ers

71%

of F

Cs

aged18-6

5

years

, of w

hom

60%

active a

t

the L

M-s

et to

incre

ase.

Som

e c

are

leave. B

ein

g

develo

ped w

ork

leaves:.

FC

s s

am

e r

ate

s

of em

plo

ym

ent

as the g

enera

l

popula

tion (

64%

of th

e p

eople

betw

een 1

8 a

nd

65 y

ears

), a

nd

sam

e e

ducation

level. F

Cs,

who

work

fullt

ime

pro

vid

e less

hours

per

week

than F

Cs w

ith a

part

-tim

e job o

r

without a job.

Incre

ase o

f fe

-

male

L.M

. par-

ticip

ation, m

igra

-

tion a

way fro

m

Yes-

volu

n-

teers

als

o

funded b

y

govt.

Low

- 4

.15 –

6%

% o

f th

e m

igra

nt

popula

tion in

nurs

ing a

nd c

ar-

ing jobs.

The

gre

ate

st im

pedi-

ment fo

r ente

ring

this

part

of th

e

LM

is r

equire-

ment fo

r hig

her

education a

nd

poor

com

mand o

f

the D

utc

h lan-

guage.

1. y

es

2

Yes –

but not

for lo

wer

levels

tho’ opport

uni-

ties f

or

on the

job tra

inin

g e

x-

ist.

134

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

pare

nts

) and

agein

g o

f F

Cs

affect tr

ends in

FC

. gro

win

g

tendency that

more

people

may c

hoose n

ot

to c

are

.

Norw

ay

5%

respondents

16-7

4 g

ave

som

e c

are

/ h

elp

to a

dults in

ow

n h

ousehold

in 2

000 (

due

to o

ld a

ge, dis

abili

ty o

r ill

-

ness).

= 1

60,0

00 p

eople

. 8%

- or

appro

xim

ate

ly 2

55,0

00

people

- h

elp

ed p

eople

in

oth

er

household

s. C

are

/

help

giv

en b

y p

eople

aged

75+

not in

clu

ded. T

ota

l in

-

form

al care

receiv

ed b

y p

eo-

ple

aged 6

7+

fro

m p

eople

in

ow

n a

s w

ell a

s o

ther

house-

hold

s, am

ounte

d to 4

9,0

00

man y

ears

. W

om

en g

ive 2

.5

tim

es a

s m

uch f

am

ily c

are

as

men. T

he g

ender

diffe

rence

is a

t its s

malle

st fo

r th

e o

ld-

est care

giv

ers

The p

roport

ion

of th

e p

opula

tion

aged 1

6-7

4 g

iv-

ing f

am

ily c

are

as w

ell a

s tim

e

spent on f

am

ily

care

has b

een

som

ew

hat re

-

duced f

rom

1990 to 2

000

people

in low

incom

e h

ouse-

hold

s m

ore

often

giv

e h

elp

to

oth

er

house-

hold

s than d

o

mem

bers

of

better-

off

household

s. B

ut

overa

ll F

C h

as

not been r

e-

duced, but has

rath

er

in-

Short

ages e

sp.

in u

rban a

reas-

hig

h turn

over

Som

e a

re d

e-

velo

pin

g

Yes-

both

info

rmal

(neig

hbours

and f

riends)

and f

orm

al in

NG

Os.

Legal m

igra

nts

import

ant un-

skill

ed c

are

work

ers

. A

lso

legally

and ille-

gally in p

rivate

hom

es. M

ain

ly

housew

ork

and

to a

very

sm

all

exte

nt care

work

for

the e

lderly.

1.

Som

e

2.

yes-

but not all

em

plo

yees

train

ed

3.

yes

135

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

cre

ased, in

the

last 30 y

ears

Pola

nd

FC

- daughte

r 37.1

%),

spouse (

29.2

%),

son

(20.9

%),

gra

ndchild

ren

(15.5

%),

92%

of O

P b

elie

ve

that in

case o

f sic

kness they

can c

ount on h

elp

fro

m their

fam

ilies

No s

pecia

l

leave. A

bout 1.3

work

and c

are

.

Pro

ble

m o

f un-

em

plo

ym

ent

am

ongst young

makes t

hem

unable

to h

elp

financia

lly.

No p

roble

m

because o

f hig

h

rate

s o

f unem

-

plo

ym

ent. B

ut

low

wages a

nd

mig

ration to

oth

er

EU

coun-

trie

s m

ay h

ave

knock o

n e

f-

fects

. P

lus f

i-

nancia

l pro

b-

lem

s m

ean less

people

hired

than n

eeded.

Ditto

– a

ll le

vels

can b

e e

m-

plo

yed

Yes –

Maltese

Associa

tion

help

ed s

tart

up a

no o

f

NG

Os.

Used in h

os-

pic

es

Very

few

for

bet-

ter

off fro

m B

ye-

loru

ssia

.

1. n

o-

very

rare

-

Alz

heim

er

gro

ups

2.

Yes f

or

sta

te

instits

. – n

ot

alw

ays in p

rac-

tice, N

ot in

pri-

vate

hom

es.

3. Y

es -

som

e

Port

ugal

Est. 2

.3%

of

pop.

care

s f

or

OP

main

ly w

om

en -

25%

of

FC

s a

re m

ale

.

Even w

hen h

ousekeeper

em

plo

yed, F

C p

ays. superv

i-

sio

n, m

anagem

ent, e

mo-

tional support

, tr

ansport

and

financia

l m

anagem

ent.

Hig

h r

ate

of

fem

ale

em

plo

y-

ment – 6

1.2

%

No p

roble

m. B

ut

pro

ble

m o

f lo

w

earn

ings –

lim

it

choic

e a

vailable

and the n

um

-

bers

recru

ited

No –

low

earn

-

ings.

Few

of th

e

50,0

00 w

ork

with O

P –

not

attra

ctive for

volu

nte

ers

.

Info

rmal sup-

port

fro

m

neig

hbours

/

frie

nds. som

e

local parish

support

thru

’

Cath

olic

Churc

h.

No o

ffic

ial data

.

Influx f

rom

E.E

uro

pe,

Ex

Port

uguese c

olo

-

nie

s c

heaper

and

hig

her

level of

qualif

ication e

sp.

wom

en a

s

housekeepers

.

Mediu

m a

nd

above incom

e

gro

ups u

se

housekeepers

–

main

ly less inti-

mate

care

of

OP

.

1.

No

2. H

eads o

f in

sti-

tutions a

nd

serv

ices a

re

qualif

ied, not

oth

ers

.

E.E

uro

peans

often m

ore

educate

d than

locals

of oth

er

mig

rants

.

3.

–

136

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

Legalised a

s

dom

estic e

m-

plo

yees.

Slo

venia

F

Cs

caring for 30-4

0,0

00

(10%

of O

P) (e

xclu

din

g those

in inst

itutions)

Daughte

rs, w

ho

were

most

fre

quently in touch

with their p

are

nts

, belo

nged to

the 3

3 to 5

5-y

ear age g

roup

and s

ons

most

ly to the 4

0 to

49-y

ear

age g

roup. It h

as

als

o

been reveale

d that si

sters

,

fem

ale

pensi

oners

, are

als

o

an im

portant part o

f th

e info

r-

mal n

etw

ork

of th

e e

lderly

Hig

h r

ate

s o

f

fem

ale

em

plo

y-

ment but in

90s

many a

t 50+

offere

d e

arly

retire

ment on full

pensi

on –

whic

h

is n

o longer pos-

sible

and w

ill

incre

ase s

train

on F

Cs

who

work

. A

ct

Am

endin

g the

Socia

l S

ecurity

Act not yet im

-

ple

mente

d b

ut

adopte

d, allo

ws

for F

Cs

to b

e

regis

tere

d a

s

‘fam

ily a

ssis

-

tants

’.

socia

l care

rs

num

bers

dro

p-

pin

g d

ue to insuf-

ficie

nt fu

nds

to

enable

additio

nal

recru

itm

ent.

Availa

ble

Y

es-

gro

wth

in

org

aniz

ations

pro

vid

ing

volu

nte

er

support

e.g

.

Red C

ross,

Carita

s.

Not applic

able

1.

som

e

2.

som

e

3.

som

e

Spain

12.4

% h

ousehold

s c

onta

in a

FC

for

the e

lderly. i.e., a

l-

most 5%

of people

over

18

giv

e info

rmal help

to a

n O

P

appro

xim

ate

tota

l of

75%

of O

P h

ave

more

than o

ne

child a

live (

av.

No n

early 3

).

Alm

ost

24%

No info

rmation

Few

em

erg

ing

private

org

an-

ized s

erv

ices.

Contr

acting

private

care

Very

sm

all

part

icip

ation

of volu

nte

ers

or

the c

hurc

h

in c

aring for

Imm

igra

nts

,

main

ly illegal,

import

ant-

, out-

sid

e h

elp

is

sought fo

r a few

1.

Som

e

2.

Yes-

full

cert

i-

fication

3.

som

e e

.g. fo

r

Alz

heim

er,

137

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

1,4

64,2

99 p

eople

, of w

hic

h

83%

are

wom

en m

ain

ly 4

5-

64 o

f lo

w level education a

nd

housew

ife. 22%

em

plo

yed

(36%

part

tim

e w

ork

64%

full

tim

e. 28%

of th

e p

opula

tion

identifies a

n e

lderly p

ers

on in

their fam

ily in n

eed o

f care

and s

pecia

l attention, and

alm

ost

21%

cla

ssify t

hem

-

selv

es a

s c

are

rs t

o s

om

e

exte

nt.

FC

s-

spouse 1

2.4

%, daugh-

ter

26%

, son 1

5%

, sis

ter

1.4

%, bro

ther

0.4

%, gra

nd-

daughte

r 8%

, gra

ndson

5.4

%, daughte

r-in

-law

5.6

%,

son-in-law

6%

oth

er

rela

tives

14%

, neig

hbours

and / o

r

care

takers

5.6

%, fr

iends 4

%,

household

em

plo

yees u

nder

1%

.

share

a h

om

e

with s

om

e c

hild

and 4

3.5

% liv

e

in the s

am

e

tow

n, B

ut gen-

era

tional and

L.M

. changes

especia

lly for

wom

en, th

ere

is

a feelin

g o

f un-

cert

ain

ty a

mong

curr

ent care

rs.

They p

erc

eiv

e a

lack o

f re

cip

roc-

ity w

ith r

espect

to the c

om

ing

genera

tions o

f

care

rs, and u

n-

cert

ain

ty a

s

regard

s the f

u-

ture

of th

ose

receiv

ing c

are

.

Esp.

acute

am

ong the o

lder

care

rs a

nd those

that are

more

alo

ne

12%

of F

Cs

sto

pped w

ork

to

deal w

ith c

aring-

Wom

en w

ithout

associa

ted w

ith

livin

g a

lone

(4X

< c

hances

of contr

acting it;

absence o

f chil-

dre

n.

OP

with

hig

h incom

e a

nd

education leads

to h

igher

use o

f

private

serv

ice

the e

lderly

(0.1

%),

hours

, but w

ith

incre

asin

g d

e-

pendency s

tays

in the h

om

e o

f

OP

Rem

ain

in t

his

work

until th

eir

situation is legal-

ised.

Pro

ble

ms:

excessiv

e w

ork

-

ing d

ays, dom

es-

tic a

ctivitie

s b

e-

yond c

aring for

the p

ers

on, lo

w

wages, ill

egal

situation. B

al-

ance is g

enera

lly

positiv

e f

or

the

fam

ilies a

nd for

the im

mig

rant

care

rs. B

oth

positiv

ely

valu

e

the a

ffective r

ela

-

tionship

s they

esta

blish w

ith the

OP

.

som

e R

egio

ns.

138

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

stu

die

s o

r w

ith

prim

ary

educa-

tion h

ave a

gre

ate

r pro

pen-

sity t

o g

ive u

p

paid

work

.

Sw

eden

“Redis

covery

” of F

C e

.g.

CA

RE

R 3

00 p

roje

ct

1. In

cre

asin

g%

OP

rely

ing o

n

FC

+ / -

serv

ices, and d

eclin

-

ing%

rely

ing o

n p

ublic

ser-

vic

es+

/ -

FC

2. > 8

0%

fem

ale

LF

part

ici-

pation. (h

ighest in

EU

)

The inte

gra

tion

of care

r support

into

the f

orm

al

serv

ice c

are

managem

ent

syste

m.

Care

work

ers

(at

all

levels

inclu

d-

ing p

hysic

ians)

majo

r pro

ble

ms

in r

ecru

itm

ent

and r

ete

ntion,

many u

ntr

ain

ed

and leavin

g L

M

(early r

etire

ment

and s

ick leave)

A h

igh s

erv

ice

syste

m f

ocusin

g

on h

om

e c

are

rath

er

than insti-

tutional.

2 /

3 O

P liv

e

alo

ne.

Public

/ p

rivate

mix

but private

is n

ot out-

of-

pocket pay-

ments

Volu

nta

ry

org

s. D

on’t

pro

vid

e h

ands

on c

are

, but

much info

rmal

volu

nte

er

help

to O

P –

3 n

at.

care

rs O

rgs

with p

ublic

fundin

g

No d

ata

1. Y

es –

fro

m

subsid

ized c

ar-

ers

’ gro

ups

2.

Yes –

in s

er-

vic

e –

only

half

of 180,0

00

work

ers

are

train

ed in

low

er

levels

.

3. Y

es-

sit in

serv

ices

Sw

itzer-

land

23.1

% o

f popula

tion a

ged

15+

have b

een c

aring -

with-

out paym

ent - fo

r a p

ers

on

aged 6

5+

in the y

ear

prior

to

surv

ey =

1.3

6 m

ill p

ers

ons.

Pre

-retire

d a

ctive p

op. 50-5

9

years

(36.9

%)

and y

oung

retire

es 6

0-6

9 y

ears

(35.1

%)

pro

vid

e m

ore

care

than o

ther

age g

roups. m

ore

than 1

out

Few

measure

s

yet in

pla

ce to

support

work

ing

FC

s. U

rban /

rura

l and c

anto

n

diffe

rences. M

en

aged 5

0-5

9 a

nd

60-6

9 y

ears

old

in e

qual pro

por-

tions a

s F

Cs

Short

ages o

f

work

ers

and

mig

rants

re-

cru

ited to w

ork

in g

eriatr

ic insti-

tutions a

nd s

er-

vic

es.

Yes, especia

lly

wom

en f

or

do-

mestic w

ork

. N

o

data

, curr

ently

bein

g s

tudie

d.

Main

ly fro

m S

.

Euro

pe a

nd L

atin

Am

erica.

–

139

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

of 4 o

lder

retire

es a

ged 7

0-

79 y

ears

old

(26.3

%)

and o

f

40-4

9 y

ears

old

(25.9

%)

pro

vid

e c

are

to a

noth

er

re-

tire

e.

F / T

paid

work

-

ers

, stu

dents

and d

isable

d

retire

es r

eport

giv

ing less c

are

(still

11.9

- 19.4

%

of

FC

s).

33%

of

retire

d, part

tim

e

work

ers

, w

ork

-

ing in t

he fam

ily

com

pany o

r at

hom

e r

eport

caring f

or

an

OP

. 21.8

% u

n-

em

plo

yed r

eport

pro

vid

ing c

are

.

UK

16%

over

the a

ge o

f 16 a

re

curr

ently c

are

rs; 1 in 5

household

s c

onta

in a

care

r.=

6.8

mill

ion p

eople

in 5

mill

ion

household

s R

egio

nal varia-

tions e

.g. N

ort

h E

ast (2

0%

)

low

est in

London (

11%

), 1

8-

19%

in N

.W., S

.W. and

Wale

s. P

eak o

f 24%

at age

45-6

4, decre

ases to 1

6%

aged 6

5+

. F

C w

om

en 1

8%

V

14%

men, no g

ender

varia-

tions in the p

roport

ions o

f

men a

nd w

om

en w

ho a

re c

o-

resid

ent care

rs. W

om

en

None identified

Recru

itm

ent and

rete

ntion a

ma-

jor

issue w

ith

respect to

both

qualif

ied a

nd

unqualif

ied s

taff.

In the form

er

casew

ork

with

old

er

people

is

not accord

ed the

valu

e a

nd s

tatu

s

of acute

care

.

With r

espect

to

unqualif

ied s

taff,

turn

over

is h

igh

See p

ublic s

ec-

tor-

sam

e.

Larg

e v

olu

n-

tary

secto

r –

many s

elf h

elp

FC

gro

ups

No d

ata

on ille

gal

mig

ration.

Mig

rants

re-

cru

ited a

nd d

is-

pro

port

ionate

ly

em

plo

yed in

health a

nd s

ocia

l

serv

ices.

1.

Yes-

St. J

ohn’s

Am

bula

nce-

pro

vid

e c

ert

ifi-

cation

2.

NV

Q q

ualif

ica-

tions f

or

form

al

but not quali-

fied p

rofe

s-

sio

nal care

rs.

Form

al pro

fes-

sio

nal care

rs

are

fully

quali-

fied a

nd r

egis

-

tere

d.

140

Co

un

try

Fam

ily c

are

rs

Tre

nd

s in

availab

ilit

y o

f

FC

Co

mb

inin

g

wo

rk a

nd

care

Pu

blic s

er-

vic

es,

lab

ou

r

su

pp

ly a

nd

tren

ds

Pri

vate

serv

ices

Vo

lun

teers

M

igra

nt

care

rs

Tra

inin

g

1.

fam

ily c

are

rs

2.

form

al care

rs

3.

vo

lun

teers

more

lik

ely

to c

are

for

som

e-

one in a

noth

er

household

(12%

/ 9

%);

to b

e the m

ain

support

er

wheth

er

in the

sam

e (

35%

/ 3

0%

) or

an-

oth

er

household

(25%

/

19%

); a

nd to p

rovid

e 2

0

hours

or

more

care

per

week

(29%

/ 2

6%

).

52%

are

lookin

g a

fter

a p

ar-

ent or

pare

nt-

on-law

, 16%

are

caring for

a s

pouse, and

8%

for

a c

hild

One third o

f

care

rs c

o-r

esid

e w

ith the

pers

on they a

re c

aring for,

while tw

o thirds liv

e in a

n-

oth

er

household

. C

o-r

esid

ent

care

rs a

re m

ore

lik

ely

to b

e

spendin

g 2

0 h

ours

a w

eek o

r

longer

pro

vid

ing c

are

(63%

/

11%

). S

pouses a

re m

ajo

rity

of co-r

esid

ent F

Cs e

specia

lly

75+

.

and w

ages low

,

furt

her

exacer-

bating a

n a

l-

ready d

ifficult

situation

3.

Yes

141

5.1

0

An

nex 1

0 –

Ma

trix

: O

ther

Iss

ue

s

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

Austr

ia

69%

FC

said

physi-

cal burd

ens; 79%

psycholo

gic

al bur-

dens; socia

l is

ola

-

tion s

evere

pro

ble

m

–

Pensio

ners

’ org

ani-

zations a

ffili

ate

d to

polit

ical part

ies.

Um

bre

lla o

rganiz

a-

tion

- Low

IT

usage b

y

OP

. M

edic

al ale

rt o

r

ala

rm s

yste

ms a

s a

pers

onal em

erg

ency

response s

yste

m

but fe

w c

overe

d -

0.2

% o

f all

people

aged 6

5 y

ears

or

over.

72%

of F

C felt

transfe

rs w

ere

im

-

port

ant. A

nd o

nly

28%

felt that in

heri-

tance p

lays "

a n

eg-

ligib

le r

ole

” in

inte

r-

genera

tional re

la-

tions.

Belg

ium

1998 s

ettin

g u

p o

f

Centr

al R

eport

Poin

t

for

Eld

erly A

buse

and C

entr

e for

help

for m

istr

eate

d e

ld-

erly p

eople

)

Yes,

import

ant.

2002-3

20%

men,

9%

wom

en 6

5-7

4

used IT

(9%

M, 2%

W Inte

rnet)

ww

w.s

enio

rweb.b

e

pro

vid

es info

rma-

tion, org

aniz

es

com

pute

r cours

es

for

eld

erly p

eople

and inte

rnet panel

dis

cussio

ns o

n top-

ics that concern

OP

and F

Cs.

No r

ole

Bulg

aria

No d

ata

-

-

-

Yes p

lay a

part

.

Sta

te inte

rvenes if

fam

ily take p

ropert

y

of O

p a

nd then d

o

not pro

vid

e c

are

.

Czech R

epublic

Only

a few

, but sev-

era

l str

ong N

GO

s o

f

- S

om

e h

om

e a

larm

syste

ms o

pera

ted

Not le

gally

142

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

O

P w

ho p

rovid

e

som

e s

erv

ices t

hat

als

o h

elp

FC

s. A

lz-

heim

er

Associa

tion

an e

xception

by Z

ivot 90 a

nd the

Centr

e o

f G

ero

nto

l-

ogy. C

zech A

lz-

heim

er

Socie

ty h

as

data

base o

f ser-

vic

es s

ee

ww

w.g

ero

nto

logie

.c

z

Denm

ark

1 s

mall

stu

dy

show

ed F

Cs e

sp.

agein

g s

pouses

pro

vid

ing c

are

and

support

are

con-

cern

ed a

bout th

eir

ow

n h

ealth a

nd

well-b

ein

g a

nd

worr

y a

bout w

hat

would

happen if

they c

ould

no longer

care

for

the s

pouse.

No d

ata

-

Yes o

ne to s

upport

coopera

tion b

e-

tween F

Cs a

nd

pro

fessio

nals

.

ww

w.p

gru

ppen.d

k -

Rela

tives o

f F

rail

Old

er

People

but

oth

er

NG

Os (

2)

als

o

support

OP

and

FC

s

less than 1

% in 1

stu

dy g

ot help

fro

m

fam

ily m

em

bers

or

oth

er

mem

bers

of

socia

l netw

ork

s w

ith

pers

onal care

that

less than 5

% a

ged

60-7

5 y

ears

liv

e

with c

hild

ren. LA

obliged to p

rovid

e

respite h

elp

to

spouses, pare

nts

or

oth

er

clo

se r

ela

tives

caring for

a p

hysi-

cally

or

menta

lly

dis

able

d p

ers

on.

U

nlikely

Fin

land

- A

bsence o

f data

3 m

ain

gro

ups –

larg

est national

wid

e, bi-lingual.

Funded b

y s

lot m

a-

chin

es A

ssocia

tion.

1 focuses o

n c

are

-

giv

ers

1 / 3

60+

get som

e

help

Yes g

ero

technolo

gy

e.g

. lo

com

otion

devic

es in / o

ut of

house, eating,

sle

epin

g, security

e.g

. tim

ers

for lights

,

locom

otion r

ecogni-

tion, security

tele

-

phone, doorb

ell

No.

Incre

ase in O

P liv

-

ing a

lone. 60%

of

75+

liv

e in 1

pers

on

household

s.

143

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

ala

rm. F

or

FC

nig

h

ala

rm-

wakes F

C u

p

if O

P m

oves f

rom

bed in n

ight.,

Fra

nce

Ris

ks o

f depre

ssio

n

is tw

ice h

igher

Am

ongst F

Cs than

in the g

enera

l popu-

lation.

Debate

on m

al-

treatm

ent and

abuse o

f O

P in insti-

tutions a

nd

at hom

e b

y info

rmal

and p

rofe

ssio

nal

care

rs

2-

but not very

str

ong in term

s o

f

impact.

No d

ata

.

Old

pare

nts

- 5

0%

have 1

child

nearb

y

(less 1

km

.), and

90%

a c

hild

liv

-

ing <

50 k

m; 31%

are

liv

ing in the

sam

e v

illage o

r

tow

n a

nd 6

7%

in the

sam

e D

epart

.

Yes, but no d

ata

e.g

. use >

mobile

phones a

nd Inte

rnet

by 5

0+

. W

ebsites

on s

ocio

-

gero

nto

logy w

ith

info

and a

dvic

e f

or

FC

s.

New

technolo

gie

s

have a

n indirect

impact on F

Cs-

thru

ala

rms

Pro

bably

but no

data

/ r

esearc

h

Germ

any

Stu

dy o

f 1911 F

Cs-

those w

ho s

pend

larg

e a

mounts

of

tim

e r

eport

ed p

hysi-

cal com

pla

ints

such

as e

xhaustion, pain

in a

rms a

nd legs,

heart

tro

uble

and

severe

sto

mach

pain

more

than f

or

genera

l popula

tion.

sym

pto

ms m

ore

pro

nounced in F

Cs

of cognitiv

ely

im

-

paired p

ers

ons

10,8

% (

n=

46)

re-

port

ed v

iole

nce,

where

as p

sycho-

logic

al m

altre

atm

ent

and fin

ancia

l dam

-

age w

ere

report

ed

more

fre

quently. -

rela

ted to >

need for

support

and c

are

+

a d

eclin

e o

f physic

al

str

ength

. D

om

estic

vio

lence h

idden.

OW

more

often the

vic

tim

s o

f dom

estic

abuse B

ut

FC

s a

ct-

ing v

iole

ntly t

ow

ard

s

their O

P o

nly

22%

2 m

ajo

r F

ounda-

tions a

nd m

any

NG

Os, pre

ssure

gro

ups a

nd F

C

gro

ups b

ut 6%

regu-

larly v

isit c

off

ee-

gro

ups f

or

FC

s o

r

counsellin

g h

ours

.

2%

meet in

private

self-h

elp

gro

ups a

nd

3%

regula

rly m

eet

in g

roups f

or fa

mily

care

rs w

ith p

rofe

s-

sio

nal counselli

ng.

Only

about 16%

of

all

FC

s r

egula

rly

and 3

7%

occasio

n-

62%

of O

P liv

e in

the s

am

e h

ousehold

with F

C, 8%

FC

s

live in t

he s

am

e

house o

r very

nearb

y, about 14%

live less than 1

0

min

ute

s a

way,

about 8%

liv

e m

ore

than 1

0 m

inute

s

aw

ay, re

main

ing 8

%

of O

P in n

eed o

f

care

no r

egula

r

fam

ily c

are

-giv

ing o

r

support

.

Am

ongst te

rmin

ally

Yes g

ero

technolo

gy

pro

mote

d in L

A

cente

rs o

r charita

ble

org

anis

ations a

nd

the g

ero

technolo

gi-

cal in

dustr

y p

ro-

vid

es the e

xhib

its

mostly f

or fr

ee b

e-

cause there

is a

gre

at in

tere

st in

sellin

g n

ew

tech-

nolo

gie

s e

.g.

"Skala

-mobile

s",

com

ple

te b

arr

ier-

free f

urn

ishin

g,

em

erg

ency-c

alls

,

adapting s

anitary

Yes im

port

ant-

stu

dy s

how

ed that

42%

people

be-

lieved s

ocia

l-

norm

ative o

blig

a-

tions f

or

FC

-giv

ing

is p

ure

ly a

ltru

istic.

Mora

l obligations

and fin

ancia

l con-

sid

era

tions a

re n

ot

mutu

ally

exclu

siv

e.

144

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

of all

report

ed c

ases

of abuse a

gain

st

OP

. A

lso u

nknow

n

no.

of

cases o

f

abuse o

f O

P a

gain

st

FC

s.

ally

take u

p c

oun-

sellin

g a

nd a

dvic

e.

ill >

81%

FC

s w

ere

fem

ale

: w

ives,

daughte

rs o

r daugh-

ters

in law

. 32%

of

these F

Cs w

ere

als

o in p

aid

em

-

plo

ym

ent and for

daughte

rs p

ropor-

tion w

as 6

1%

!; 8

7%

of th

em

additio

nally

were

responsib

le for

their o

wn h

ousehold

environm

ent or

sev-

era

l applia

nces in

ord

er

to b

ala

nce

functional handi-

caps o

r im

pair-

ments

.

Gre

ece

No d

ata

. S

mall

old

qualita

tive s

tudy o

f

24 F

Cs, 8 h

ad b

ad

health, 11 d

ete

rio-

rating h

ealth. 7

clin

ical depre

ssio

n.

Only

3 n

o p

sycho-

logic

al pro

ble

ms.

50%

mentioned

positiv

e a

spects

of

care

.

data

fro

m 1

989 –

know

n f

inancia

l and

em

otional abuse in

som

e c

ases

Virtu

ally

no g

enera

l

care

rs’ gro

ups a

nd

no r

epre

senta

tion a

t

national le

vel. E

xis

t-

ing o

nes a

re for

care

rs o

f th

ose w

ith

Alz

heim

er-

over

20

of th

ese.

No d

ata

. 42%

of all

FC

s a

ssess t

o b

e

rath

er

heavy a

nd

41%

of

FC

s e

x-

trem

ely

physic

ally

and m

enta

lly b

ur-

dened a

nd o

nly

7%

assessed n

o to b

e

burd

ened

mobile tele

phone

has h

elp

ed c

om

mu-

nic

ations b

etw

een

FC

and O

P. Low

rate

s o

f In

tern

et

connection a

mongst

OP

.

Yes-

recip

rocity

import

ant. P

ropert

y

often tra

nsf

err

ed a

t

marr

iage o

f chil-

dre

n, w

ith p

are

nts

havin

g u

sage.

Hungary

30-5

0%

of people

in

the 7

0-7

9 y

ears

age

gro

up, and m

aj of

OP

> 8

0 y

ears

need

help

in d

ay-t

o-d

ay

activitie

s

No d

ata

. P

re 1

990

the p

ractice o

f con-

tracts

for

support

gave o

pport

unitie

s

for

abuse a

gain

st

the e

lderly. T

oday

one o

f th

e g

reate

st

pro

ble

ms is r

obbery

of th

e e

lderly.

The larg

e N

GO

s

work

to s

upport

and

train

FC

s.

80%

of O

P c

ounte

d

on F

C in o

ffic

ial

affairs, household

tasks a

nd n

urs

ing.

Few

er

can c

ount on

financia

l help

Ala

rm b

ell

syste

ms

– low

tech b

ut af-

ford

able

and lin

ked

OP

to f

am

ilies a

nd

neig

hbours

thro

ugh-

out countr

y. socia

l

and f

am

ily c

onnec-

tions o

f th

e e

lderly

Yes –

private

ow

n-

ers

hip

as a

resourc

e

for

OP

that th

ey c

an

pass o

n to c

hild

ren.

Recip

rocity a

nd g

ifts

from

pare

nt to

child

thro

ughout lif

e.

Irela

nd

Overload h

as n

ega-

Y

es 4

.

½ in s

epara

te

70 c

om

munity

Recip

rocity a

de-

145

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

tive e

ffect

on p

hysi-

cal &

menta

l w

ell

bein

g –

at risk

gro

ups f

or

ow

n

health

24%

FC

in p

oor

health, 30%

thought

health h

as s

uff

ere

d,

25%

inju

red.

Caring f

or

Care

rs-

69 g

roups, C

are

rs

Assoc-

16 g

roups, +

2 o

thers

.

household

s.

Hours

incre

ase w

ith

dependency.

76.8

% c

are

for

1

pers

on, 19.8

% f

or

2.

3,4

% f

or

3+

1-1

9 h

rs-

60.3

% F

C

13.4

% -

30-4

9 h

rs.

26.7

% -

50 h

rs +

.

based p

roje

cts

sup-

port

ed C

om

munity

Applic

ation o

f IT

–

Caring f

or

Care

rs

initia

ted IT

pro

ject

with M

id W

este

rn

Health B

oard

,

CIC

entr

e E

nnis

and

Ennis

I A

ge T

ow

n.

Targ

et gro

up 1

500

not

yet m

ain

-

str

eam

ed.

Poorly d

evelo

ped

and p

oor

legis

lation.

Inte

rnet fo

r shop-

pin

g.

bate

– incre

asin

g

role

of gra

ndpar-

ents

. in

child

care

Only

anecdota

lly.

Inherita

nce o

f hom

e

– Issue w

heth

er

fam

ily h

om

e +

oth

er

assets

should

be

taken into

consid

-

era

tion f

or fu

ndin

g

LT

C.

Italy

-

Eld

er

abuse d

is-

cussed w

ith r

ef to

resid

ential hom

es

but le

ss s

o a

bout

FC

. R

esults o

n F

Cs

feelin

g tyra

nnis

ed

by O

P a

lso a

ppar-

ent (s

pouses a

nd

daughte

rs e

spe-

cia

lly m

ention this

).

2 m

ajo

r A

lzheim

er

gro

ups w

ork

ing

nationally

.

A.U

.S.E

.R.

(NG

O

for

eld

erly c

are

)

recently p

ublis

hed a

“manifesto

of care

rs’

rights

” and a

na-

tional confe

rence o

n

“Support

ing c

are

rs

for

the r

ights

of th

e

pers

ons c

are

d f

or”

H

igh c

ost, m

ain

ly

private

ly p

aid

- S

e-

curity

ala

rm s

ys-

tem

s, vid

eo-

tele

phones, m

echa-

niz

ed s

hutter

lock,

tele

-medic

ine d

e-

vic

es, tr

ansponder

or

mechanis

ed d

oor

(or

win

dow

) opener,

data

netw

ork

(fo

r

rapid

share

d a

ccess

to Inte

rnet)

, bed-

room

inte

rcom

, vis

-

ual and a

uditory

sig

nals

, re

mote

contr

ol appara

tus o

f

Pro

ble

ms o

f guard

i-

anship

of O

P p

rop-

ert

y if th

ey a

re n

ot

able

to look a

fter

them

selv

es.

146

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

cert

ain

functions v

ia

phone, S

MS

or

Inte

rnet, Inte

rnet

websites f

or

FC

s

main

ly d

edic

ate

d to

fam

ilies o

f A

lz-

heim

er’s a

nd p

sy-

chia

tric

patients

.

Luxem

bourg

N

o d

ata

.

No d

ata

N

o –

Alz

heim

er

Socie

ty o

f LU

part

ly

and m

any o

rganiz

a-

tions inclu

din

g

NG

Os f

or

them

but

not

of

them

. B

ut

there

are

3 o

rgani-

zations o

f senio

r

citiz

ens.

35%

of dependent

people

needed in

excess o

f 24 h

ours

per

week. M

ean

tim

e w

as 2

1.2

hours

. – this

has

incre

ased.

3.5

hrs

-13.9

9-3

8.5

%

14-2

3.9

9 –

26.5

24-3

3.9

9 –

20.8

34-4

3.9

9 –

7.4

44-6

3.9

9 –

4.6

64-8

3.5

– 2

.1

But

this

coves

younger

people

–

and m

ore

tim

e

needed b

y y

ounger

(19-4

0)

sin

ce h

andi-

capped. B

ut next

gro

up a

re those

aged 9

0+

, th

en 8

0-

89, 70-7

9.

Tele

Ala

rm,

Senio

r hot lin

es

pro

vid

e info

rmation

Luxem

bourg

pro

-

gra

mm

es a

nd w

eb

site

ww

w.luxsenio

r.lu

?

Malta

No s

tudie

s-

1 d

one

- N

o c

are

rs g

roups,

- T

ele

care

T

he m

ajo

rity

of

147

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

with 1

00 F

Cs for

this

report

. 65.6

per

cent

of

the inte

r-

vie

wed f

am

ily c

are

rs

replied that th

ey

spend w

hole

day in

the c

are

of th

eir O

P,

there

are

pensio

n-

ers

org

aniz

ations

Serv

ice lin

ks O

P

with F

Cs.

Malta’s

eld

erly p

er-

sons b

equeath

their p

ropert

y to the

child w

ho takes c

are

of th

em

when they

becom

e d

ependent.

Deep e

mbedm

ent in

fam

ily s

upport

net-

work

s o

f in

terd

e-

pendence, of giv

ing

and r

eceiv

ing. O

P

are

a b

oon to their

work

ing c

hildre

n

e.g

. financia

l assis

-

tance, baby s

itting,

etc

, conflic

t re

solu

-

tion.

Neth

erlands

150-2

00,0

00 F

Cs

over

/ burd

ened if

part

ner

or

spouse

because involv

es

care

for

24 / 7

/ 1

2,

more

oft

en d

eprived

of in

com

e, use less

serv

ices f

or

FC

s.

FC

s u

nder

65 h

ave

more

tro

uble

com

-

bin

ing w

ork

and

care

when p

rovid

ing

pers

onal care

and /

or

psychosocia

l or

em

otional support

.

11%

of

FC

s o

f O

P

with d

em

entia h

ad

engaged in p

hysic

al

aggre

ssio

n. 30%

of

FC

s r

eport

ed

chro

nic

verb

al ag-

gre

ssio

n

Many s

uch g

roups

inclu

din

g s

upport

cente

rs f

or

info

rmal

care

rs (

and the

national org

aniz

a-

tion for

these s

up-

port

cente

rs X

zorg

),

volu

nta

ry (

term

inal)

hom

e c

are

org

ani-

zations, org

aniz

a-

tion for

info

rmal

care

giv

ers

(LO

T),

and the E

xpert

ise

cente

r fo

r In

form

al

Care

(E

IZ).

2,4

mill

ion p

eople

19%

of th

e D

utc

h

popula

tion o

ver

18

years

pro

vid

e F

C a

t

least 3 m

onth

s +

or

8+

hrs

per

week.

400,0

00 (

18.8

% o

f

all

FC

) in

tense c

are

for

65+, 830,0

00

long term

less in-

tense. A

v. F

C h

elp

for

17.9

hours

per

week F

C g

ive d

o-

mestic h

elp

(75%

)

psychosocia

l sup-

Houses a

re c

reate

d

in w

hic

h p

eople

can

live thro

ughout th

eir

whole

lifespan w

ith

ala

rm s

yste

ms, IC

T-

technolo

gy e

tc.

Som

e p

rofe

ssio

nal

hom

e c

are

org

ani-

sations a

re o

ffering

com

pute

r te

chnolo

-

gie

s f

or

old

er

people

and their c

are

giv

ers

to a

sk n

urs

es b

y the

use o

f w

ebcam

s

and inte

rnet ques-

No d

ata

148

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

.

port

(81%

), p

ers

onal

care

(34%

), though

for

term

inally

ill

FC

s

pro

vid

e m

uch p

er-

sonal assis

tance

(66%

). 6

7%

of F

Cs

giv

e m

ultip

le f

orm

s

of care

. 40%

FC

s

without assis

tance

60%

get help

fro

m

secondary

info

rmal

care

giv

ers

.

tions a

bout care

Norw

ay

FC

spouses o

f O

P

with d

em

entia found

that th

e m

ajo

rity

report

negative e

f-

fects

of

care

giv

ing

on their o

wn h

ealth

Estim

ate

d a

s b

e-

tween 3

% a

nd 6

% -

stu

die

s in the N

ord

ic

countr

ies a

buse o

f

eld

erly v

aries f

rom

1%

to 8

%. M

ore

frequent experi-

ences o

f vio

lence b

y

mid

dle

and O

W in

citie

s. (5

%)

than

countr

y.

Volu

nta

ry o

rganis

a-

tions for

eld

erly a

nd

for

FC

s t

o g

ive in-

form

ation a

nd s

up-

port

as w

ell a

s b

e-

ing w

atc

h d

ogs a

nd

co-o

pera

ting a

gents

in r

ela

tion to the

form

al serv

ice s

ys-

tem

. 13%

(but

risin

g

nos o

f) L

As h

ad

esta

blished s

upport

gro

ups f

or

care

giv

-

ers

; fe

wer

had s

pe-

cia

l cours

es, tr

ain

-

ing o

r consultation

serv

ices f

or

care

-

giv

ers

.

Stu

dy o

f com

ple

te

cohort

fro

m a

ge 8

0

to the d

eath

of each

cohort

mem

ber

show

ed t

ota

l no.

of

years

of F

C r

e-

ceiv

ed b

y w

om

en

was o

n a

vera

ge 8

.8

years

and f

or

men

5.3

years

(i.e. after

the c

are

receiv

er

reached the a

ge o

f

80).

Hrs

of in

form

al

care

to o

lder

(and

dis

able

d)

people

incre

ase w

ith a

ge o

f

care

giv

er,

with a

peak f

or

mid

dle

aged w

om

en (

aged

45-6

6 y

ears

)

Wom

en g

ive 2

.5

There

are

Offic

es

for

Assis

tive A

ids in

every

County

.

Safe

ty a

larm

s a

nd

oth

er

equip

ment are

wid

ely

used b

y e

ld-

erly a

nd their c

ar-

ers

.

Yes-

consid

era

ble

transfe

rs f

rom

OP

as inherita

nce, pre

-

inherita

nce a

nd g

ifts

though this

is s

how

n

not to

influence the

am

ount of care

giv

er

to o

lder

par-

ents

by c

hild

ren -

genera

lly. If p

are

nts

are

in n

eed o

f nurs

-

ing, pre

vio

us h

elp

from

pare

nts

to

childre

n r

esult in

more

nurs

ing b

y

childre

n, and m

ost

so f

or

fath

ers

Eld

-

erly in g

enera

l giv

e

more

help

and e

co-

nom

ic s

upport

to the

younger

genera

-

149

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

tim

es a

s m

uch f.

c.

as m

en.

wom

en

giv

e m

ore

help

than

men d

o to o

ther

household

s –

no

diffe

rences w

ithin

sam

e h

ousehold

.

tions, com

pare

d to

the h

elp

they r

e-

ceiv

e. F

or m

oth

ers

am

ount of help

re-

ceiv

ed a

lso d

e-

pends o

n w

heth

er

she h

ad h

elp

ed h

er

childre

n

Pola

nd

No d

ata

N

o d

ata

. E

xtr

em

e

cases in s

om

e p

ri-

vate

hom

es.

Not F

Cs. P

ensio

n-

ers

’ org

aniz

ations

affili

ate

d to p

olit

ical

part

ies.

No n

ational data

.

Where

co r

esid

ent

difficult to m

easure

– s

om

e s

tudie

s

have s

uggeste

d 1

00

hours

a w

eek,

No d

ata

Y

es-

legally

con-

trolle

d. Im

port

ance

of re

cip

rocity –

esp.

sin

ce s

o m

any a

re

co-r

esid

ent, a

nd

support

of O

p p

en-

sio

n f

or

unem

-

plo

yed.

Port

ugal

56.1

% d

epre

ssio

n

(26.5

% s

evere

,

modera

te)

Needs a

nd p

rob-

lem

s v

ary

by in-

com

e levels

– lei-

sure

an issue f

or

the

better

off, financia

l

help

for

the w

ors

e

off

.

No a

ccura

te d

ata

.

Researc

h r

eveals

very

little –

main

ly

em

otional or

psy-

cholo

gic

al abuse.

(aff

ective b

lackm

ail

by b

oth

part

ies)

No r

ep. gro

ups o

f

FC

s.

Som

e A

lz-

heim

er,

Park

inson

gro

ups.

Where

they e

xis

t

NG

Os a

re e

ffective

in im

pro

vin

g local

initia

tives a

nd p

rovi-

sio

ns. (e

.g. tr

ain

ing,

support

in k

ind, self

help

)

39%

care

alo

ne,

61%

have s

upport

from

socia

l agen-

cie

s, re

latives o

r

housekeeper.

68.3

% c

are

for

more

than 4

hours

p.d

..

56.6

% c

are

every

day, 6.9

% o

cca-

sio

nally, 17.2

% F

C

relies o

n form

al

support

, 6.9

% h

ave

rota

tional care

.

Gre

en P

aper

1997

to f

avour

dis

advan-

taged in Inf. S

oc.

Netw

ork

of

dis

able

d

and e

lderly, M

in. of

scie

nce a

nd T

ech-

nolo

gy o

ffers

fre

e

Inte

rnet.

Port

ugal T

ele

com

(text, t

ext

phone,

Grid. em

erg

ency

term

inal w

ith fre

e

hand p

hone,. A

larm

Serv

ice,, p

ort

able

am

plif

ier,

lum

inous

call

sig

n,

dis

counts

,

Not pro

pert

y, but

exchange o

f goods

and s

erv

ices a

nd

recip

rocity

150

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

financia

l fa

cili

ties in

gain

ing a

ccess to

equip

ment.

Slo

venia

FC

s very

isola

ted

and h

igh b

odily

and

physi

cal st

rain

s

(27.3

%). N

o s

pare

tim

e(1

5%

) and less

tim

e for th

eir fam

ily

(10%

). F

Cs

most

mis

s financia

l help

and h

om

e h

elp

; th

e

third p

lace o

ccupie

d

by h

elp

in a

ccom

mo-

dation o

f O

P in O

P

hom

e 4

5.8

% c

are

rs

did

not know

who to

turn

to for help

.

½ O

P a

buse

d b

y

their c

hild

ren. F

am

ily

mem

bers

or re

lativ

es

were

resp

onsi

ble

for

thre

e q

uarters

of

incid

ences

of abuse

.

FC

s com

mit a

buse

because they a

re s

o

worn

out.

10,9

% f

rom

institu

-

tion w

here

they

lived.

Not per

se b

ut

str

ong N

GO

s –

esp.

Pensio

ners

Asso-

cia

tions

> 2

/ 3

OP

receiv

ed

help

fro

m c

lose

rela

-

tives

severa

l tim

es

a

week a

nd a

50%

every

day. S

om

e

FC

s caring for 2

pers

ons.

FC

. 52.5

%

caring for th

eir p

ar-

ents

for over 6 y

ears

and 1

/ 3

for > 1

0

years

. < 1

/ 3

for up

to o

ne y

ear.

Type o

f help

by F

Cs-

handlin

g fin

ance

(80%

rs)

, household

task

s (7

5%

), a

ccom

-

panyin

g (70%

), h

elp

with n

utritio

n (62.5

%)

nurs

ing a

nd p

ers

onal

hygie

ne (55%

). latter

pro

vid

ed b

y d

iffere

nt

pers

ons

– c

hild

ren

(53.6

%), o

ther clo

se

rela

tives

(39.3

%) and

hom

e n

urs

es

(28.6

%)

‘Red b

utton’,

tele

-

ala

rm s

yst

em

of th

e

Hom

e h

elp

centre

offering h

elp

to p

eo-

ple

in a

health c

risi

s

and the lonely

ones

is n

ot gain

ing u

sers

desp

ite h

eavy in

-

vest

ments

into

it.

Critical im

port

ance

of re

cip

rocity –

esp.

curr

ently w

here

hig

h

unem

plo

ym

ent ra

tes

and f

am

ilies g

et

support

fro

m O

P.

Can b

e m

isused

where

FC

is n

ot a

rela

tive…

How

ever

OP

unw

ill-

ing to s

ee larg

e

apart

ments

sin

ce

they w

ish to leave

pro

pert

y to their

childre

n-

so w

on’t

pay for

care

.

Spain

C

om

bin

ing F

C a

nd

work

ing o

ut of

hom

e

negative h

ealth

effects

.- incre

ase in

Only

academ

ic d

e-

bate

– n

o r

eso-

nance,

Yes.

Especia

lly

Alz

heim

er’ g

roups –

subsid

ized b

y g

ovt.

56%

of F

Cs p

rovid

e

daily c

are

; 22%

every

week, 14%

occasio

nal. M

ostly

Tele

-assis

tance w

as

giv

en to less than

1%

of th

e e

lder

63%

of F

Cs indic

ate

that O

P d

o n

ot

giv

en them

an e

co-

nom

ic r

ew

ard

, 23%

151

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

morb

idity, w

ors

ens

perc

eption o

f health

sta

tus, and in-

cre

ases u

se o

f H

Ss.

64%

FC

s less lei-

sure

, 51%

tired,

48%

no h

oliday,

39%

no v

isit to

frie

nds, 32%

de-

pre

ssed, 29%

health d

ete

riora

ted,

27%

can’t w

ork

,

26%

No t

ime t

o look

after

oth

er

people

,

23%

no t

ime f

or

them

selv

es,

21%

financia

l pro

ble

ms,

12%

reduced their

work

ing d

ay, 12%

gave u

p w

ork

, 9%

conflic

ts w

ith p

art

-

ner.

71.4

% o

f m

ain

care

rs p

sycholo

gi-

cally

not w

ell

OP

in a

ssocia

tions

of pensio

ners

or

wid

ow

s a

lso s

ubsi-

dis

ed p

ublicly

or

by

non p

rofit-

makin

g

entities, in

tended t

o

encoura

ge the e

ld-

erly to lead a

n a

c-

tive life a

nd to o

ffer

them

a m

ediu

m for

socia

lisin

g.

all

day o

r tw

o h

ours

a d

ay

FC

spends a

v. 7 h

rs

a d

ay c

aring, and

may r

eceiv

e h

elp

one h

our

a d

ay.

Fro

m r

est

of

net-

work

Hig

h%

of O

P in

Spain

report

fair to

bad h

ealth

59%

liv

e togeth

er

perm

anently, 16%

live togeth

er

tem

po-

rarily

, 26%

liv

e in

separa

te d

wellin

gs

or

in o

ther

form

s –

larg

e u

rban / r

ura

l

variations in liv

ing

alo

ne f

or

OP

.

Inte

rnet gro

win

g-

for

FC

s "

The E

xpert

s

Centr

e"

experim

ent

to r

esolv

e p

roble

ms

in c

aring for

the

eld

erly, sponsore

d

by the R

ed C

ross

and the O

bra

Socia

l

de C

aja

Madrid. A

website o

ffering a

consultin

g s

erv

ice

Users

are

able

to

find fre

e p

rofe

s-

sio

nal advic

e o

n

e.g

. health, m

eals

,

advic

e o

n legal and

busin

ess m

atters

,

volu

nte

er

forc

e,

addic

tion e

tc.

regula

rly r

eceiv

e

com

pensation a

nd

13%

do f

rom

tim

e t

o

tim

e.

Negative p

erc

eption

of th

e im

pact of

caring o

n the fam

ily

econom

y b

ut an

expense e

specia

lly

in fam

ilies w

ith a

mediu

m-low

eco-

nom

ic s

tatu

s, sin

ce

pensio

ns a

re low

and d

oes n

ot cover

the c

osts

they

cause

Sw

eden

No d

ata

N

o d

ata

though

recogniz

ed a

s a

pro

ble

m e

specia

lly

where

caring f

orc

ed

on F

C -

Yes -

3 m

ain

gro

ups

gro

win

g in im

por-

tance -

Dem

entia

Associa

tion (

1984)

has a

bout 12 0

00

mem

bers

and 1

10

local org

anis

ations

in m

ost are

as; T

he

Alz

heim

er

Associa

-

No d

ata

3 Y

r action p

lan

(1999-2

001)

stim

u-

lating L

As to d

e-

velo

p a

n infr

astr

uc-

ture

of

serv

ices

targ

eting fam

ily

care

giv

ers

. T

he p

lan

funded L

As to e

x-

pand s

erv

ices for

No d

ata

though

assets

of

diffe

rent

kin

ds p

lay a

role

in

the n

egotiation o

f

fam

ily o

blig

ation

152

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

tion S

weden, (1

987.

the C

are

rs S

weden,

1996 -

national um

-

bre

lla o

rganis

ation,

and to p

rom

ote

care

rs´

inte

rest on a

bro

ad s

cale

,

thro

ugh a

dvocacy-,

info

rmation-

and

aw

are

ness r

ais

ing

activitie

s.

care

rs e

.g.

by s

et-

ting u

p c

are

giv

er

resourc

e c

entr

es

that off

er

train

ing,

counsellin

g, support

gro

ups, re

spite

care

, in

form

ation

and r

esourc

es f

or

fam

ily c

are

giv

ers

,

inclu

din

g d

ay p

ro-

gra

ms f

or

their d

is-

able

d f

am

ily m

em

-

bers

. T

he e

xperi-

ences a

nd o

utc

om

e

of th

e C

are

r-300

pro

ject has b

een

syste

matically

fol-

low

ed a

nd e

valu

-

ate

d the r

ecent

years

. A

CT

ION

tele

matics inte

rven-

tion p

rogra

mm

e

used w

ith 4

0 fam

i-

lies is s

uccessfu

l.

Sw

itzerland

Stu

dy c

om

paring N

and S

canto

ns

show

ed d

iffe

rences

40%

report

ed d

e-

pre

ssio

n, 26%

of

Basel F

Cs &

18%

of

FC

s in T

icin

o

show

ed d

epre

ssiv

e

sym

pto

ms.

In B

asel,

Under

exam

ined b

ut

n N

GO

exis

ts t

o

deal w

ith a

buse.

Yes-

for

Alz

heim

er

and o

ther

/

Majo

rity

FC

s p

ro-

vid

e 3

- 2

0 h

rs p

.m.,

the p

eak d

ura

tion

bein

g 6

-10 h

rs c

are

p.m

. W

om

en s

pend

only

a v

ery

slig

ht

am

ount

of tim

e

more

than m

en p

.w.

16.4

% o

f m

en a

nd

153

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

up to 7

0%

of F

Cs

indic

ate

d h

ealth-

rela

ted p

roble

ms.

18.9

% o

f w

om

en

giv

e 2

1 h

ours

+ for

FC

p.m

.

Mem

bers

of th

e

fam

ily p

rovid

e a

n

avera

ge o

f 17.9

hours

of

care

per

week o

ver

a m

ean

dura

tion o

f 6.5

years

UK

D

iffe

rences in la-

bour

mark

et in

-

com

es a

fter

epi-

sodes o

f care

2 / 3

or

4 y

ears

not dif-

fere

nt fr

om

those

not

involv

ed in c

are

over

these inte

rvals

,

but lo

nger

epis

odes

rela

ted to larg

er

gaps in incom

es

betw

een c

are

rs a

nd

non-c

are

rs. w

ith s

ix

or

2,4

00 c

om

pla

ints

made to A

ction o

n

Eld

er

Abuse 5

0%

appro

x b

y r

ela

tives,

28%

by a

paid

work

er,

11%

by a

frie

nd o

f th

e v

ictim

,

most

cases t

akin

g

pla

ce in t

he v

ictim

's

ow

n h

om

e. A

ccord

-

ing to the s

urv

ey,

one in thre

e o

ld

people

suff

ers

som

e

form

of psycholo

gi-

cal abuse; one in

five is p

hysic

ally

abused a

nd the

sam

e n

um

ber

have

their s

avin

gs inap-

pro

priate

ly u

sed;

more

than 1

0%

are

negle

cte

d a

nd 2

.4%

sexually a

bused

Care

rs U

K led b

y

care

rs w

ith N

ational

and r

egio

nal offic

es

114.

Incom

e fro

m

public g

rants

(36%

)

19%

donations f

rom

trusts

and p

ublic

bodie

s, 15%

fro

m

legacie

s, 6%

fro

m

corp

ora

te d

onations

and s

ponsors

hip

,

and 4

% f

rom

mem

-

bers

hip

subscrip-

tions.

Princess R

oyal

Tru

st fo

r C

are

rs –

113 n

etw

ork

s. O

ffer

gra

nts

and tra

inin

g.

Cro

ssro

ads C

aring

for

Care

rs –

202

centr

es –

for

bre

aks

to 3

9,0

00 c

are

rs

4 m

illio

n c

are

rs

work

and c

are

(1 / 9

wom

en a

nd 1

/ 1

0

men c

om

bin

ing

work

with the s

up-

port

of

a fra

il old

er

pers

on

Socia

l S

erv

ices m

ay

pro

vid

e text phones,

flashin

g o

r vib

rating

ala

rm c

locks o

r door

bells a

nd loop s

ys-

tem

s f

or

liste

nin

g t

o

the tele

vis

ion. D

is-

able

d liv

ing c

entr

es

pro

vid

e a

dvic

e a

nd

access t

o m

od.

Support

technolo

-

gie

s in U

K e

.g. E

nvi-

ronm

enta

l contr

ol

syste

ms., P

Cs,

CD

-

Rom

s a

nd IS

DN

lines p

rovid

e O

P

and F

Cs w

ith a

c-

cess to info

rmation.

When s

om

eone

goes into

a r

esid

en-

tial hom

e they m

ay

be r

equired to s

ell

their h

om

e, so indi-

vid

uals

who a

re

likely

to b

enefit fr

om

the inherita

nce o

f

pro

pert

y m

ay b

e

influenced in their

decis

ion to c

are

for

their e

lderly r

ela

tive.

154

Co

un

trie

s

Healt

h a

nd

Well-

bein

g o

f F

C

Ab

use in

FC

sit

ua-

tio

ns

Care

rs g

rou

ps

Ho

urs

of

care

,

Resp

on

sib

ilit

y f

or

FC

New

tech

no

log

ies

Pro

pert

y a

nd

in

-

heri

tan

ce &

recip

-

rocit

y

with p

aid

, tr

ain

ed

care

sta

ff.

155

Documents

Elizabeth Mestheneos and Judy Triantafillou on behalf of ... · week for their dependent elderly (65+) family members in different regional sites. The family carers were interviewed