22nd european social services conference – rome, 7-9 july 2014 social and healthcare integration...
TRANSCRIPT
22nd European Social Services Conference – Rome, 7-9 July 2014
Social and healthcare integration
Lazio Regional Authority strategyto support people with Alzheimer’s
Workshop presented by:Regione Lazio, Italia
Diapositiva 2 di 16
€ 160 billion: the total estimated cost of dementia disorders in EU27 in 2008 56% of which were costs of informal (unpaid) care
Source: Anders Wimo, 2008 – in Alzheimer Europe
7.3 million people with dementia in EU27numbers expected to at least double by 2040
€ 22.000 per person per year: the average cost with dementia in EU27
Alzheimer’s in EuropeCONTEXT
22nd European Social Services Conference – Rome, 7-9 July 2014
Diapositiva 3 di 16
In Italy, more than 1 million people are affected by dementia
600.000 affected by Alzheimer's disease Total cost of dementia is estimated beyond 29 billions € The cost per demented is about 28.600 €
Direct costs are 15% of the total,i.e. 4.500 € per demented
Informal care costs are 85% of total cost, i.e. 24.100 € per dementedSource: Alzheimer Europe, 2008
Source: Alzheimer Italia, 2011 e Alzheimer Europe, 2008
Alzheimer’s in ItalyCONTEXT
Sweden
Italy0
20406080
100
Informal care costDirect cost
22nd European Social Services Conference – Rome, 7-9 July 2014
Diapositiva 4 di 16
Total inhabitants of Lazio: 5.500.000 Inhabitants aged 65+: 1.100.000 Estimated dementia incidence: 71.000
(6% of population aged 65+) Estimated Alzheimer’s incidence: 40.000 (55% of all
dementias) Actual patients in care affected by dementia: 36.000
Direct costs Medical exams, hospital stays, medicines Formal care: home care, day care centers Nursing homes Financial support to demented and
families: disability pensions, vouchers for assistance, etc.
Direct costs Direct share of health and social service costs Costs for assistance personnel and aid tools
Informal care costs Loss of productivity (for both demented and family
members) Psychological and physical stress and pain for
informal caregivers
Costs incurred by families (80%) Costs incurred by public sector (20%)
Alzheimer’s in LazioCONTEXT
22nd European Social Services Conference – Rome, 7-9 July 2014
Diapositiva 5 di 16
The 2013 World Report on Alzheimer’s outlines the following main Recommendations:
Governments around the world should make dementia a priority by implementing national plans…
Monitor the quality of dementia care in all settings
Autonomy and choice should be promoted at all stages of the dementia journey
Health and social care systems should be better integrated Need to train caregivers and to provide them with financial reward Quality of life at home can be as good, and costs are comparable
The quality of care in care homes should be monitored through the quality of life and satisfaction of their residents
World Report on Alzheimer’s 2013CONTEXT
22nd European Social Services Conference – Rome, 7-9 July 2014
Diapositiva 6 di 16
L. 104/1992 – National law on assistance, social inclusion and rights of the disabled
L.R. 6/2012 – Regional Plan for people affected by Alzheimer-Perusini’s and other dementias
National level Lazio Region
A national plan on Alzheimer’s is to be approved
It defines the service network, access procedures, some governance tools such as the Dementias Information System and the Dementias Regional Register.
Services are designed as follows:• Centres for diagnosis and medical treatment• Semi-residential/Residential services (both health and social care)• Home care• Financial support to families and to volunteering associations• Training courses for caregivers + information for demented and
families• Register and Information system
Regulatory framework in ItalyCONTEXT
22nd European Social Services Conference – Rome, 7-9 July 2014
Objectives To foster a multidimensional approach to
Alzheimer's disease To realize and integrated network of health
and social services for demented and their families
To even out the services offer on the whole of regional territory
National and regional resources in 2012Fund for disability (non self sufficient persons, LSA, dementias, etc.) € 119.600.000,00
Specific fund for Alzheimer's € 7.000.000,00 (DGR 504/2012)
Overview on the Regional PlanREGIONAL POLICY
€ 7.000.000,00
National resources
Regional resources
22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 7 di 16
1. New social units coinciding with health units
2. Integrated health-and-social actions
3. Bottom up process in service design and delivery
4. Service standardization
5. Online monitoring and financial reporting
Outstanding featuresREGIONAL POLICY
22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 8 di 16
Health units (ASL)
Health Social
8 new social units coinciding with health units and formed by social districts
Social Districts and new social scope units
New social unitsREGIONAL POLICY
22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 9 di 16
Health Social
• New social services units: coinciding with health units
• Shared design of Individual Assistance plan (PAI)
• Shared methodology between social services and health sector
• Shared services delivery with health sector
Social & healthcare integrationREGIONAL POLICY
22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 10 di 16
Residential / semi-residential Day-care centres and short-term residen-tial
Direct and indirect home-care
Information and training Alzheimer's Café, self-mutual help, caregivers' training
53
41
6
Resources destinationREGIONAL POLICY
22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 11 di 16
Diapositiva 12 di 1622nd European Social Services Conference – Rome, 7-9 July 2014
Outcome
Day care centres for Alzheimer's
Short term residential service
Service offer in 2012: 19 day care centres with 400 placesIncrease of service offer in 2014: 8 new day care centres and 140 places
Criticalities
High start up and management costs
Uncertainty about level of financial resources through different years
Service offer in 2012: 120 short term residential placesIncrease of service offer in 2014: 30 short term residential places
Territorial diversity in service offer: 17 day care centres in Rome
Residential & semiRESULTS AND PERFORMANCE
Diapositiva 13 di 1622nd European Social Services Conference – Rome, 7-9 July 2014
Outcome
Direct and indirect home-care
Current offer: 8.500 users
Increase of:
500 new users who will receive home-care
Uneven service supply:
from six months to one year
from 12 to 44 hours per month
from 100 to 800 € per month
Criticalities
Home care is the most requested service innon-metropolitan areas
Home-careRESULTS AND PERFORMANCE
Diapositiva 14 di 1622nd European Social Services Conference – Rome, 7-9 July 2014
Criticalities
Information to families Self-mutual help of informal care-giversAlzheimer CafèCare-givers training
Outcome
Uneven use of financial resources and kind of service delivered
New places for socialization (Alzheimer Café)
Development of family networks
Training for 130 formal and informal caregiversCare-givers often get little Alzheimer’s specific training
Information & trainingRESULTS AND PERFORMANCE
Diapositiva 15 di 1622nd European Social Services Conference – Rome, 7-9 July 2014
Guidelines in service supplying
Online application for monitoring and financial reporting
Widening of type and quantity of supplyed services
Summing up… on the positive side
ConclusionsRESULTS AND PERFORMANCE
Diapositiva 16 di 1622nd European Social Services Conference – Rome, 7-9 July 2014
Lack of specific standards for services (access procedures, fruition, territorial characteristics, functions, costs)
Uneven territorial distribution of service supplying (cultural and social differences, infrastructure, etc.)
Summing up… the critical sides
ConclusionsRESULTS AND PERFORMANCE