erasmus+ 2015 sector skills alliances...deliverable 2.1 erasmus+ 2015 sector skills alliances...

Deliverable 2.1

ERASMUS+ 2015

SECTOR SKILLS ALLIANCES

AGREEMENT No. 2015 – 3212 / 001 – 001

PROJECT No. 562634-EPP-1-2015-IT-EPPKA2-SSA

WP responsible: OMNIA

Deliverable responsible: SI4LIFE

WP starting month M1

WP ending month M5

Partner Contributor(s): Liguria Region, Si4Life, Ggallery, VE-II, AGE-Platform, OMNIA, FNBE, Super, AYTO, UVA, SGGCYL, Pro. Vi Hub, ARS

Partner Reviewer(s): OMNIA

*Dissemination Level: PU=Public CO=Confidential, only for members of the Alliance (including Commission Services). PP=Restricted to external subjects in confidential mode (including Commission Services) RE=Restricted to a group specified by the Alliance (including Commission Services).

**Nature of Deliverables: R=Report P=Prototype D=Demonstrator O=Other

Deliverable Number: 2.1

Title of Deliverable: Identification of the existing HHCPs, their role, Skill and competencies in elderly homecare sector in Europe

WP related to the Deliverable: WP2

Dissemination Level: (PU/PP/RE/CO)*: PU

Nature of the Deliverable: (R/P/D/O)**: O

Actual Date of Delivery to the CEC: 31/05/2016

Deliverable 2.1

562634-EPP-1-2015-IT-EPPKA2-SSA CARESS Project 2 of 418

1 ABSTRACT:

The WP 2 is the general preparation work package, collecting and mapping background information for the

design of the EU Framework (WP3), the design of national pilots (WP3) and their implementation (WP4 and

WP5) and evaluation (WP6).

Task 2.1, in particular, is aimed at the identification of the existing HHCPs, their role, skill and competencies in

older adults homecare sector in Europe. This document reports the main results of T2.1 activities.

2 KEYWORDS:

Homecare; Home Healthcare Practitioner; Older Adults; Competencies; Skills; Roles

3 LIST OF BENEFICIARIES (PP-RE)/PARTICIPANTS (PU-CO)***

Ben. No. Beneficiary Name Short Name Country

1 Si4Life – Scienza e Impresa Insieme per Migliorare la

Qualità della Vita s.c.r.l.

Si4Life Italy

2 Regione Liguria Liguria Region Italy

3 Ggallery s.r.l. GGallery Italy

4 I.T.C. “Vittorio Emanuele II-Ruffini” VE-II Italy

5 AGE-Platform AGE Belgium

6 OMNIA OMNIA Finland

7 Finnish National Board of Education FNBE Finland

8 Super SUPER Finland

9 Ayuntamiento de Valladolid AYTO Spain

10 Universidad de Valladolid UVA Spain

11 Sociedad de Geriatría y Gerontología de Castilla y León SGGCYL Spain

12 Associazione Polo Tecnico Professionale Professioni Vita Pro. Vi Hub Italy

13 Azienda Regionale Sanitaria Ligure ARS Italy

14 Royal Cornwall Hospitals Trust RCHT UK

15 United Kingdom Homecare Association UKHCA UK

16 Nestor Primecare Services Ltd – Allied Healthcare Allied Healthcare UK

Deliverable 2.1


*** List of Beneficiaries In case of dissemination level PU or CO please indicate all the partners involved in this Deliverable. In case of dissemination level PP please indicate the names of the other subject to whom the deliverable is devoted In case of dissemination level RE please indicate the restricted group of partners.

VERSION HISTORY

VERSION PRIMARY AUTHORS VERSION DESCRIPTION DATE COMPLETED

0 SI4LIFE – Serena Alvino Deliverable structure 19/02/2016

1 SI4LIFE – Serena Alvino, Daniele

Musian, Barbara Mazzarino

First draft 15/05/2016

6 SI4LIFE – Serena Alvino, Daniele

Musian, Barbara Mazzarino

Final version 31/05/2016

4 AUTHORS

SECTION AUTHORS PARTNER TYPE NAME OF PARTNER

INTRODUCTION Serena Alvino Full Partner SI4LIFE

ELDER CARE IN EUROPE

OVERVIEW

Philippe Seidel ; Borja

Arrue

Full Partner Age Platform

OLDER PERSONS HOMECARE IN

ITALY

Isabella Roba

Serena Alvino

Associated Part.

Full Partner

ARS Liguria

SI4LIFE

Homecare for older people with

disability

Fabio Marcenaro

Ilaria Scala

Aldo Moretti

Associated Part.

Pro.Vi Hub

Report on questionnaires

targeting Italian HHCPs

Barbara Mazzarino Full Partner SI4LIFE

Report on interviews targeting

older adults experiencing

homecare in Italy

Daniele Musian Full Partner SI4LIFE

Deliverable 2.1



HHCP involved in older persons

homecare service in Italy: roles

and competences

PHYSIOTHERAPISTS:

Luca Francini

Elisa Pelosin

Daniela Garaventa

NURSES:

Loredana Sasso

Angela Bagnasco

PROFESSIONAL

EDUCATORS:

Nicola Titta

Mario Saiano

Davide Ceron

Monica Miatto

AIFI Liguria

University of

Genoa -

Physiotherapists

Faculty

University of

Genoa - Nurses

Faculty

ANEP -

Associazione

Nazionale

Educatori

Professionali

Supporting Partner

Supporting Partner

Supporting Partner

Supporting Partner

OVERVIEW ON THE OLDER

PERSONS HOMECARE SERVICE

IN SPAIN

MJ. Castro. MJ Cao. Leonor Pérez. José Mª Jiménez.

F.Javier Blanco. Lourdes Ausin. Alba Canteli. Virtudes Niño.

Caridad Torrecilla. Carmen García de la Torre Azucena Jiménez.

Full Partners Uva-Nursing. SGCYL.

VCC

Deliverable 2.1



Report on primary data about

homecare service in Spain



Caridad Torrecilla. Azucena Jiménez. Carmen García de la Torre J. Ignacio Asensio


VCC, Uva-tech


homecare service in spain: roles

and competences



Caridad Torrecilla. Carmen García de la Torre Azucena Jiménez.


VCC


FINLAND

Overview on the older persons

homecare service in Finland

Report on primary data about

homecare service in Finland


homecare service in Finland:

roles and competences

Sirje Hassinen

Nina Kauppinen and

Sanna Hosio

Sirje Hassinen, Asta

Kaitila and Isabel

Poikkimäki

full partner Omnia


AUSTRIA

Michele Scarrone

Lucia Schifano

full partner Regione Liguria


BELGIUM

Philippe Seidel ; Borja

Arrue

full partner AGE platform

Deliverable 2.1




BULGARIA

Serena Alvino full partner SI4LIFE


CROATIA

Caridad Torrecilla

Gómez

Azucena Jiménez

López

Full partner VCC

Introduction to older persons

homecare service in Croatia

Caridad Torrecilla

Gómez

Azucena Jiménez

López

Full partner VCC


homecare service in Croatia:


Caridad Torrecilla

Gómez

Azucena Jiménez

López

Full partner VCC


CYPROS

Caridad Torrecilla

Gómez

Azucena Jiménez

López

Full partner VCC


CEZ REPUBLIC

Barbara Mazzarino full partner SI4LIFE


DENMARK

Paula Soivio full partner Super


ESTONIA

Sirje Hassinen full partner Omnia


FRANCE

Maria Rosaria Troiani

Benedetto Montanari

full partner Vittorio Emanuele II


GERMANY



GREECE

Daniele Musian full partner SI4LIFE

Deliverable 2.1




HUNGARY

F.Javier Blanco Lourdes Ausin Alba Canteli Virtudes Niño

full partner SGCYL


Latvia



LITHUANIA



LUXEMBOURG



MALTA

Michele Scarrone

Lucia Schifano



NETHERLANDS

Michele Scarrone

Lucia Schifano



POLAND

Michele Scarrone

Lucia Schifano



PORTUGAL


full partner SGCYL


ROMANIA


full partner SGCYL


SLOVAKIA

Serena Alvino full partner SI4LIFE


SWEDEN

Paula Soivio/ full partner Super

Deliverable 2.1




THE UNITED KINGDOM

Caridad Torrecilla

Gómez

Azucena Jiménez

López

Full partner VCC


NORWAY



ICELAND


5 Sommario

1 ABSTRACT: ....................................................................................................................................................... 2

2 KEYWORDS: ..................................................................................................................................................... 2

3 LIST OF BENEFICIARIES (PP-RE)/PARTICIPANTS (PU-CO)*** ........................................................................... 2

4 AUTHORS ......................................................................................................................................................... 3

6 INTRODUCTION: STRUCTURE AND AIMS OF THE DOCUMENT ..................................................................... 14

7 ELDERCARE IN EUROPE OVERVIEW ............................................................................................................... 15

7.1 The challenges ....................................................................................................................................... 16

7.2 The responses ........................................................................................................................................ 17

8 OLDER PERSONS HOMECARE IN ITALY .......................................................................................................... 18

8.1 Overview on the older persons homecare service in Italy .................................................................... 18

8.1.1 The need and the supply for homecare ........................................................................................ 18

8.1.2 Health homecare and home nursing ............................................................................................. 22

8.1.3 Home help ..................................................................................................................................... 25

8.1.4 Private health and social homecare .............................................................................................. 30

8.2 Homecare for older people with disabilities in Italy ............................................................................. 32

8.2.1 Legislation and recommendations on home care for persons with disability in Italy ................... 32

8.2.2 Responsibilities: Who is responsible for homecare (public/private sector, voluntary etc), who

organize homecare? ...................................................................................................................................... 32

8.2.3 Actors in disabled people home care ............................................................................................ 32

8.2.4 Access and care delivery process .................................................................................................. 33

8.2.5 Access model ................................................................................................................................. 33

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8.2.6 The financing of homecare service for persons with disability ..................................................... 33

8.2.7 Disabled people homecare challenges in Italy .............................................................................. 34

8.3 Report on questionnaires targeting Italian HHCPs ................................................................................ 34

8.3.1 QUESTIONNAIRE SESSION 1: ACTUAL ACTIVITY AS A PROFESSIONAL........................................... 35

8.3.2 QUESTIONNAIRE SESSION 2: TARGETED NEEDS AND COMPETENCES IN AN IDEAL HOMECARE . 51

8.3.3 QUESTIONNAIRE SESSION 4: EVALUATION OF OLDER PERSONS’ NEEDS...................................... 57

8.3.4 QUESTIONNAIRE SESSION 5: ROLE OF THE HOMECARE PROVIDER ORGANIZATION IN THE

DELIVERY OF THE SERVICE ............................................................................................................................. 57

8.4 Report on interviews targeting older adults experiencing homecare in Italy ....................................... 58

8.5 HHCP involved in older persons homecare service in Italy: roles and competences ............................ 63

8.5.1 Nurses ............................................................................................................................................ 63

8.5.2 Physiotherapists ............................................................................................................................ 69

8.5.3 Psychologist ................................................................................................................................... 77

8.5.4 Professional Educator .................................................................................................................... 85

8.5.5 Occupational Therapist .................................................................................................................. 89

8.5.6 Social Health Operator (OSS) ......................................................................................................... 94

8.5.7 Homecare assistant / home helper ............................................................................................... 98

8.5.8 Social Guardian ............................................................................................................................ 100

8.5.9 References ................................................................................................................................... 102

9 OLDER PERSONS HOMECARE IN SPAIN ....................................................................................................... 104

9.1 Overview on the older persons homecare service in Spain ................................................................ 104

9.2 Report on primary data about homecare service in Spain .................................................................. 105

9.3 HHCP involved in older persons homecare service in Spain: roles and competences ........................ 109

9.3.1 REFERENCES ................................................................................................................................. 121

10 OLDER PERSONS HOMECARE IN FINLAND .............................................................................................. 121

10.1 Overview on the older persons homecare service in Finland ............................................................. 121

10.1.1 Challenges of the Finnish home care ........................................................................................... 124

10.1.2 References ................................................................................................................................... 125

10.2 Analysis of activities, skills and competences of home health care practitioners in Finland.............. 125

10.2.1 MATERIAL AND METHODS .......................................................................................................... 125

10.2.2 RESULTS ....................................................................................................................................... 127

10.2.3 DISCUSSION ................................................................................................................................. 134

10.2.4 References ................................................................................................................................... 137

10.3 Home care clients’ perceptions of quality of care and staff competence .......................................... 138

10.3.1 Purpose of the study ................................................................................................................... 138

Deliverable 2.1


10.3.2 Material and methods ................................................................................................................. 139

10.3.3 Results ......................................................................................................................................... 140

CARE NEEDS AND PRIORITY OF THE CARE NEEDS ....................................................................................... 141

COMPETENCE AND SKILLS OF THE PRACTICAL NURSES .............................................................................. 141

10.3.4 Discussion .................................................................................................................................... 143

10.3.5 References ................................................................................................................................... 144

10.4 HHCP involved in older persons homecare service in Finland: roles and competences ..................... 145

11 OLDER PERSONS HOMECARE IN AUSTRIA ............................................................................................... 153

11.1 Introduction to older persons homecare service in Austria ................................................................ 153

11.2 HHCP involved in older persons homecare service in Austria: roles and competences ..................... 160

11.2.1 References ................................................................................................................................... 173

12 OLDER PERSONS HOMECARE IN BELGIUM .............................................................................................. 174

12.1 Introduction to older persons homecare service in Belgium .............................................................. 174

12.2 HHCP involved in older persons homecare service in Belgium: roles and competences ................... 175

12.2.1 Nursing auxiliary (‘aide soignant’) ............................................................................................... 176

12.2.2 Nurses .......................................................................................................................................... 177

12.2.3 Social Assistants ........................................................................................................................... 179

12.2.4 Family helper (‘aide familiale’) .................................................................................................... 180

12.3 Sources: ............................................................................................................................................... 181

13 OLDER PERSONS HOMECARE IN BULGARIA ............................................................................................ 182

13.1 Introduction to older persons homecare service in Bulgaria .............................................................. 182

13.1.1 Home healthcare in Bulgaria ....................................................................................................... 183

13.1.2 Social homecare in Bulgaria......................................................................................................... 183

13.1.3 The role of NGOs and Bulgarian Red Cross ................................................................................. 184

13.1.4 “Home Care and Assistance Services towards Independent and Dignified Life” Project ........... 185

13.2 HHCP involved in older persons homecare service in Bulgaria: roles and competences ................... 186

13.2.1 References ................................................................................................................................... 194

14 OLDER PERSONS HOMECARE IN CROATIA .............................................................................................. 195

14.1 Introduction to older persons homecare service in Croatia ............................................................... 195

14.2 HHCP involved in older persons homecare service in Croatia: roles and competences ..................... 197

14.2.1 References ................................................................................................................................... 210

15 OLDER PERSONS HOMECARE IN CYPROS ................................................................................................ 210

15.1 Overview on the older persons homecare service in Cypros .............................................................. 210

15.2 HHCP involved in older persons homecare service in Cypros: roles and competences ..................... 213

15.2.1 REFERENCES ................................................................................................................................. 225

Deliverable 2.1


16 OLDER PERSONS HOMECARE IN CZECH REPUBLIC .................................................................................. 226

16.1 Overview on the older persons homecare service in Czech Republic ................................................. 226

16.1.1 REGULATION ................................................................................................................................ 226

16.1.2 HOME-CARE PROVIDED SERVICES ............................................................................................... 227

16.2 HHCP involved in older persons homecare service in Czech Republic: roles and competences ........ 228

16.2.1 References ................................................................................................................................... 230

17 OLDER PERSONS HOMECARE IN DENMARK ............................................................................................ 230

17.1 Introduction to older persons homecare service in Denmark ............................................................ 230

Background information about dementia and home care services ............................................................ 230

17.2 HHCP involved in older persons homecare service in Denmark: roles and competences .................. 233

17.2.1 Social- and health service assistants ........................................................................................... 233

17.2.2 Social- and health service helper ................................................................................................. 234

17.2.3 References ................................................................................................................................... 234

18 OLDER PERSONS HOMECARE IN ESTONIA ............................................................................................... 235

18.1 Introduction to older persons homecare service in Estonia ............................................................... 235

18.2 HHCP involved in older persons homecare service in Estonia: roles and competences ..................... 238

18.2.1 References ................................................................................................................................... 243

19 OLDER PERSONS HOMECARE IN FRANCE ................................................................................................ 244

19.1 Introduction to older persons homecare service in France ................................................................ 244

19.2 HHCP involved in older persons homecare service in France: roles and competences ...................... 247

20 OLDER PERSONS HOMECARE IN GERMANY ............................................................................................ 254

20.1 Overview on the older persons homecare service in Germany .......................................................... 254

20.2 HHCP involved in older persons homecare service in Germany: roles and competences .................. 258

20.2.1 References ................................................................................................................................... 261

21 OLDER PERSONS HOMECARE IN GREECE ................................................................................................ 262

21.1 Overview on the older persons homecare service in Greece ............................................................. 262

21.1.1 The context of home care ............................................................................................................ 262

21.2 HHCP involved in older persons homecare service in Greece: roles and competences ..................... 262

21.3 HHCP involved in older persons homecare service in Greece: roles and competences ..................... 264

22 OLDER PERSONS HOMECARE IN HUNGARY ............................................................................................ 270

22.1 Overview on the older persons homecare service in Hungary ........................................................... 270

22.2 HHCP involved in older persons homecare service in Hungary: roles and competences ................... 271

23 OLDER PERSONS HOMECARE IN IRELAND ............................................................................................... 275

23.1 Introduction to older persons homecare service in Ireland ................................................................ 275

23.2 HHCP involved in older persons homecare service in Ireland: roles and competences ..................... 277

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23.2.1 References ................................................................................................................................... 279

24 OLDER PERSONS HOMECARE IN LATVIA ................................................................................................. 280

24.1 Introduction to older persons homecare service in Latvia .................................................................. 280

24.2 HHCP involved in older persons homecare service in Latvia: roles and competences ....................... 283

24.2.1 References ................................................................................................................................... 284

25 OLDER PERSONS HOMECARE IN LITHUANIA ........................................................................................... 285

25.1 Introduction to older persons homecare service in Lithuania ............................................................ 285

25.2 HHCP involved in older persons homecare service in Lithuania: roles and competences .................. 288

25.2.1 References ................................................................................................................................... 291

26 OLDER PERSONS HOMECARE IN LUXEMBOURG ..................................................................................... 292

Background information about dementia and home care services .............................................................. 292

Legislation relating to the provision of home care services .......................................................................... 292

Organisation and financing of home care services ........................................................................................ 292

Kinds of home care services available ........................................................................................................... 293

26.1.1 References ................................................................................................................................... 294

27 OLDER PERSONS HOMECARE IN MALTA ................................................................................................. 294

27.1 Introduction to older persons homecare service in Malta .................................................................. 294

27.2 HHCP involved in older persons homecare service in Malta: roles and competences ....................... 301

27.2.1 References ................................................................................................................................... 310

28 OLDER PERSONS HOMECARE IN NETHERLANDS ..................................................................................... 311

28.1 Introduction to older persons homecare service in Netherlands ....................................................... 311

28.1.1 References ................................................................................................................................... 318

28.2 HHCP involved in older persons homecare service in Netherlands: roles and competences ............. 318

NURSES ........................................................................................................................................................ 319

29 OLDER PERSONS HOMECARE IN POLAND ............................................................................................... 328

29.1 Introduction to older persons homecare service in Poland ................................................................ 328

29.2 HHCP involved in older persons homecare service in Poland: roles and competences ..................... 334

29.2.1 References ................................................................................................................................... 337

30 OLDER PERSONS HOMECARE IN PORTUGAL ........................................................................................... 338

30.1 Introduction to older persons homecare service in Portugal ............................................................. 338

30.1.1 Home of care continued health and support teams ................................................................... 338

30.1.2 Home care service ....................................................................................................................... 339

30.2 HHCP involved in older persons homecare service in Portugal: roles and competences ................... 340

31 OLDER PERSONS HOMECARE IN ROMANIA............................................................................................. 343

31.1 Introduction to older persons homecare service in Romania ............................................................. 343

Deliverable 2.1


31.2 HHCP involved in older persons homecare service in Romania: roles and competences .................. 344

32 OLDER PERSONS HOMECARE IN SLOVAKIA ............................................................................................. 348

32.1 Overview on the older persons homecare service in Slovakia ............................................................ 348

32.1.1 Home healthcare in Slovakia ....................................................................................................... 349

32.1.2 Social homecare in Slovakia ........................................................................................................ 350

32.2 HHCP involved in older persons homecare service in Slovakia: roles and competences ................... 350

32.2.1 References ................................................................................................................................... 353

33 OLDER PERSONS HOMECARE IN SWEDEN ............................................................................................... 354

33.1.1 References ................................................................................................................................... 356

34 OLDER PERSONS HOMECARE IN UK ........................................................................................................ 357

34.1 Introduction to older persons homecare service in UK....................................................................... 357

34.2 HHCP involved in older persons homecare service in UK: roles and competences ............................ 360

35 OLDER PERSONS HOMECARE IN SWITZERLAND ...................................................................................... 367

35.1 Introduction to older persons homecare service in Switzerland ........................................................ 367

35.2 HHCP involved in older persons homecare service in Switzerland: roles and competences .............. 369

35.2.1 References ................................................................................................................................... 371

36 OLDER PERSONS HOMECARE IN NORWAY .............................................................................................. 372

36.1 Introduction to older persons homecare service in Norway............................................................... 372

36.1.1 References ................................................................................................................................... 376

36.2 HHCP involved in older persons homecare service in Norway: roles and competences .................... 376

37 OLDER PERSONS HOMECARE IN ICELAND ............................................................................................... 377

37.1.1 References ................................................................................................................................... 380

38 Annex 1: Questionnaire targeting HHCPs ................................................................................................ 382

39 Annex 2: Structured interview to older adults ........................................................................................ 404

40 Annex 3: Finnish questionnaire targeting HHCPs: detailed percentages of knowledges, skills and

competences (KSC) .............................................................................................................................................. 411

40.1.1 ........................................................................................................................................................... 414

40.1.2 General knowledge, skills and competences for procedures for monitoring healthy lifestyles . 415

Deliverable 2.1


6 INTRODUCTION: STRUCTURE AND AIMS OF THE DOCUMENT

The WP 2 is the general preparation work package, collecting and mapping background information for the

design of the EU Framework (WP3), the design of national pilots (WP3) and their implementation (WP4 and

WP5) and evaluation (WP6).

Task 2.1, in particular, is aimed at the identification of the existing HHCPs, their role, skill and competencies in

older adults homecare sector in Europe. This document reports the main results of T2.1 activities.

Each partner involved in the task has contributed to data collection and analysis.

For all of the EU countries, partners have gathered secondary data by collecting available literature, statistics,

available researches/projects results about the specific sector and other available documentation. Specific

contacts have been set with professional associations in order to have a clearer picture of HHCP competencies

in the particular country.

EU project, such as EQUIP I and EQUIP II (funded under Lifelong Learning Programme), the ANCIEN Project

(Assessing Needs of Care in European Nations, http://www.ancien-longtermcare.eu/) financed under the 7th

EU Research Framework Programme, ELLAN Project (European Later Life Active Network -

http://ellan.savonia.fi/) funded with support from the Lifelong Learning Programme, and fundamental EU

reports, such as

- Genet N, Boerma W, Kroneman M, Hutchinson A, Saltman RB. Home Care Across Europe: Current

Structure and Future Challenges. Copenhagen: World Health Organization; 2012.

- Genet N, Boerma W, Kroneman M, Hutchinson A, Saltman RB. Home Care Across Europe: Case studies.

Copenhagen: World Health Organization; 2012.

- World Health Organization. "WHO global strategy on people-centred and integrated health services:

interim report." (2015).

have been taken as reference for the work.

For Italy, Spain and Finland, which are the countries covered by the project partnership, primary data have

been collected in addition to secondary ones. At local level, partners have worked for collecting primary data

using 2 tools developed within the partnership:

- A Questionnaire targeting Home Healthcare Practitioners aimed at collecting data about their actual

activities in homecare, their competencies and their attitude to lifelong learning (Annex I);

- A structured interview targeting older adults (over 65) aimed at collecting information about the

homecare service they experienced and their needs (Annex II).

The Questionnaire targeting Home Healthcare Practitioners

A shared English version of the questionnaire has been developed collaboratively within the partnership. It

should be aimed to gather data useful for drawing down D2.1, D2.2 and D2.3.

The questionnaire is composed by 7 sections:

• Section 0: is aimed at identifying the type of professional who is filling in the questionnaire;

Deliverable 2.1


• Section 1: is focused on HHCPs ACTUAL activity as a professional in homecare (what really happens

when they provide their service at the older person’s own home);

• Section 2: is focused on an IDEAL situation, asking HHCPs to identify possible further older persons’

needs to address and possible further competencies necessary to target them;

• Section 3: (optional) is aimed at pointing out HHCPs opinion about their relationship with the user;

• Section 4: is aimed to understand how HHCPs evaluate older persons’ needs;

• Section 5: (optional) is focused on the role of the homecare provider organization in the delivery of the

service;

• Section 6: is aimed at gathering data about educational and career pathways of the HHCPs;

• Section 7: is aimed to identify HHCPs attitude toward lifelong learning.

The shared version of the English questionnaire has been translated into Italian, Spanish and Finnish and some

items has been customized according to contextual elements (eg. the list of possible HHCPs). Then partners

implemented locally an online questionnaire using specific tools (eg. Limesurvey

https://www.limesurvey.org/).

The structured interview targeting older adults

A shared English version of the structure (sections and items) has been developed collaboratively within the

partnership. It should be aimed to gather data useful for drawing down D2.1, D2.2 and D2.3. Then, the Project

Coordinator has developed a tool (to be printed on paper) that should be used by interviewers to provide

questions and to take notes during the interviews. The tool has been translated into Italian, Spanish and

Finnish in order to be used by local interviewers.

The tool for structured interview is composed by xx sections:

• Section 0: is aimed at gathering data about the older adult (age, sex, educational level, etc.) and about

the homecare service he/she has experienced (asking to refer to only one service/experience).

• Section 1: is aimed at pointing out the older adult perception about the ACTUAL activities the HHCP

(tasks, times, etc.)

• Section 2: is aimed at identifying the user needs that have been fulfilled by the service and needs that

have been not fulfilled but they’d like to be fulfilled.

• Section 3: is focused on older adult opinion about abilities or characteristics that they consider

fundamental for an homecare professional and about aspects they consider have improved their

quality of life since the homecare professional assist them.

Interviews have been carried out both personally and by phone.

7 ELDERCARE IN EUROPE OVERVIEW

Eldercare, often known as long-term care, can be defined as the support – both health and social care –

provided to older people with a chronic illness and/or suffering a loss of autonomy, which can bring to

dependency. A first basic distinction can be established between care delivered at home – home care – and

care in institutions – both residential care and nursing homes. Current approaches to long-term care tend to

challenge these categories and aim at creating new methods of care delivery that fully respect the dignity of

the care recipient.

Deliverable 2.1


As highlighted by Eurostat (see Figure 1), in 2009 about a half of European citizens aged 65 could expect to live

less than half of their remaining years free of conditions affecting their autonomy, i.e. their ability to manage

daily living activities.

Figure 1 Life expectancy compered to healthy years life

7.1 The challenges

These numbers show that a significant proportion of older people will need care at some point of their lives.

Moreover, the demographic trends will only increase the demand for eldercare. However, and despite the

wide disparity between European countries, there is an overall shortage of qualified care professionals in

Europe, as well as insufficient public provision of services and benefits to support those in need of care.

Moreover, care is often delivered in an uncoordinated way, which has a negative impact on the quality of the

care and the quality of life of the people in need of care.

Another challenge relates to the availability of services that are affordable and accessible to all those in need.

As shown in Figure 2, public spending in long-term care varies widely between European countries.

Figure 2 Public expenditure as % of GDP in European countries, all ages

Despite the relative generosity of long-term care systems of several European countries, overall 30% of

citizens in Europe lack access to quality long-term care, according to the International Labour Organization

(ILO), and affordability remains an issue given the only partial coverage of long-term care needs by social

protection systems. While some countries developed a specific social insurance to cover long-term care needs,

the right to receive care is weakly or not enforced in many European countries.

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The respect of the dignity of older people in need of care is a major challenge. Situations of neglect and abuse

are still frequent, and elder abuse may be affecting up to 25% of older people. Abuse is sometimes related to

the inability of informal carers – unpaid family members, neighbours or relatives caring for a person with long-

term care needs – to cope with the stress and burden associated with caring responsibilities.

7.2 The responses

Eldercare has traditionally focused on supporting those older people with a chronic condition and/or in loss of

autonomy. While this remains the main mission of eldercare, new approaches have stressed the importance of

developing services enabling prevention of the care needs linked to a loss of autonomy and rehabilitation of

those who already suffered a condition limiting their autonomy. These new approaches, encouraged by

European-level policies on social investment, are aligned with the objective of enabling active and healthy

ageing in Europe as means to address demographic ageing.

Developing quality person-centred eldercare also means integrating health and social care. Several European

regions, often within European research projects, have developed pilots of integrated care, meaning the

sharing of health and social information between care professionals and the development of shared decision-

making and care planning. Integrating the different types of care that an individual receives, at home and/or in

institutions/care facilities, proves to be a necessity in order to deliver the best possible care experience and

optimise the use of resources.

A rights-based approach to care, in full respect of the dignity and self-determination of the care recipient, has

also been highlighted as the means to fight against elder abuse and neglect, against discrimination, and also as

the basis to develop fully comprehensive long-term care systems that can offer affordable services to all those

in need of care. Developing services to support informal carers, for instance through psychological support in

respite facilities, has been highlighted as a necessary measure to accompany the development of eldercare

services.

As stated in the European Charter of Fundamental Rights, article 25, “the Union recognises and respects the

rights of the elderly to lead a life of dignity and independence and to participate in social and cultural life”.

Proactive and preventative policy approaches, such as the development of age-friendly environments, are

meant to guarantee full participation of older people to social, economic and cultural life as long as possible,

which should help prevent the need for eldercare.

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8 OLDER PERSONS HOMECARE IN ITALY

8.1 Overview on the older persons homecare service in Italy

The healthcare policies that took place in Italy at the end of the 70s reflected all the developments that

affected the matters related to healthcare.

We basically transitioned from a situation where health used to mean ‘absence of any kind of disease’ to a

more global concept of disease not only because it was seen as a “ global idea of physical, mental and social

health according to the WHO, but also because of the close link between the health and social aspects that

concern the same person and the significant role played by the community, the life, working, environmental,

economic and cultural conditions one lives in. [Genoa 2008]

The integration between policies and services plays a central role in the integration process that should involve

all the services for people. [Maciocco & Scopetani, 2010] This process is still difficult though because it has

developed in two separate directions one sanitary and the other one social. This gap has been made bigger by

a combination between public, private and social players that play a part with different roles and importance.

The basic laws on healthcare can be found in the main principles of the Republican Constitution (articles 2 and

3).

These articles recognize and guarantee on one hand the fundamental human rights , while requiring ‘ the

fulfillment of the mandatory duties of political economic and social solidarity ‘ , on the other hand it is stated

the so-called principle of substantial equality which establishes the duty for the Republic to remove all

economic and social obstacles that limit equality among citizens. Articles 32 and articles 38 focuses on the

healthcare protection (art 32) and social assistance (art 38) but they immediately show that these two areas

are on a different level: the first is seen as a fundamental right that must be granted to all people while the

second is just a right granted to the people that do not have the basic means to live. A new law was issued in

2000 (Law 328) but it was strongly softened though with the Reformation of the Fifth Title of the constitution.

Therefore the relation between the healthcare system and the social system as disciplined by law is not even.

The healthcare system seems to be the most important aspect while the social system seems to be just a part

that must be integrated with the first one. Furthermore, the basic levels of social services have not yet been

defined at National level . This leads to a lack of funding by the State. Evidently this situation prevents a real

integration between the healthcare and the sanitary systems resulting in a serious difficulty in managing all the

human and material resources available at their best potential.

8.1.1 The need and the supply for homecare

Italy is one of the countries in which the ageing society is most problematic. In Italy the population aging

process is ongoing since several years, including the increasing of the old age index, reduction of the young

population, increase of life expectancy. Due to these reasons the old age/young ratio, it is becoming alarming,

reaching the 151,4 % in 2013 and 154,1 in 2014. At regional level Liguria is the one that has the higher old age

index 239,5% as registered for years, followed by Friuli Venezia Giulia (196,1%) and Tuscany 190,1%.

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Figure 3: Italian population distributed by gender and by age in 1901, 1951, 2009 and 2030 [ISTAT, 2010]

Between 2014 and 2050, the old age dependency ratio1 is expected to increase from 54,6 (64.7 in Liguria) to

an extreme 61 (less than 2 persons of working age for one elderly person), and the mean age will increase

from 43 to 49 years [data 2014 - ISTAT]. The most intense growth, certainly compared to the rest of Europe, is

in the age group of 85+ which will more than triple, up to 7.8% of the total population in 2050. Information

available on the health status of Italians is contradictory.

At age 65, men can expect to live further 18,9 years and women 22,6 years [data 2014 - ISTAT], both living

longer than an average European at that age. However, the years lived in the absence of limitations in

functioning/disability at that age falls down to 7.7 years for men and 7.1 for women [data 2013 – EUROSTAT].

Hence, the need for care may be relatively large.

However, the share of persons over 65 reporting a long-standing illness or health problem is much lower

(55.4%) than for Europeans (56.8% of women and 52.8% of men for the age group over 65 years; data 2013-

EUROSTAT).

In Table 1 is represented the percentage of over 65 people with functional impairment distributed per region

and impairment type.

1 The dependency ratio is obtained by comparing the non active population population (from 0 to 14 years of age and

from 65 years of age and over) with the working population (from 15 to 64 years of age). This comparison which is usually multiplied per one-hundred indicates the demographic load on the active population. The figures that are over 50% indicate a generational imbalance.

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Figure 4 Demographic prevision 2007-2051 [ISTAT]

Types of functional limitations

Region Confinement Limitations in daily life activities

Limitations related to movement

Sight, hearing and speech limitations

Total %

Piemonte 6,3 9,0 8,8 3,7 14,7

Valle d’Aosta 7,2 9,1 9,1 3,3 14,4

Liguria 7,4 9,9 8,4 2,9 15,0

Lombardia 7,9 9,5 7,7 3,5 15,7

Trentino Alto Adige 4,1 10,4 7,3 4,8 15,3

P.A. Bolzano 3,3 9,4 6,2 4,0 14,9

P.A. Trento 5,0 11,4 8,3 5,5 15,8

Veneto 7,6 12,4 9,3 4,6 18,7

Friuli Venezia Giulia 9,7 11,2 9,0 4,6 17,4

Emilia Romagna 7,2 12,3 9,2 4,7 17,9

Toscana 8,5 9,8 10,5 4,6 17,6

Umbria 8,3 15,3 11,8 6,2 21,3

Marche 10,0 13,7 9,0 5,2 19,2

Lazio 9,5 12,2 9,6 5,7 19,4

Abruzzo 8,8 13,1 7,6 6,2 19,2

Molise 9,4 12,2 11,9 4,9 20,6

Campania 12,9 16,2 12,4 7,4 25,2

Puglia 14,3 18,7 13,4 6,6 26,9

Basilicata 9,3 11,2 8,4 7,6 19,7

Calabria 10,9 15,3 11,5 7,1 22,8

Sicilia 12,8 16,8 13,8 6,3 25,5

Sardegna 10,6 17,0 13,8 5,8 25,4

Italia 9,4 12,8 10,2 5,2 19,8 Table 1 Percentage of over 65 people with functional impairment distributed by region and impairment type (year 2013) [ISTAT]

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In Italy the responsibility for home care is shared between the Regional government (Local Health

Authority/Districts), which manages home health care, and the Local government (Municipality), which

manages social homecare.

The local governments accredit private providers of home help. Law 328/2000 stressed the importance of

decentralizing the management of services (Ministry of Work and Social Policy, 2006) to for profit/ non-profit

organizations, social cooperatives, volunteer organizations and other private organizations, through the

authorization to deliver the services by Municipalities.

Privately paid home social care is largely an informal market and often out of public regulations (Pesaresi,

2007a). Some attempts of a regularization of the private home aid market have been made in specific

municipalities, such as online databases of professionals, but this is not managed at systematic level.

Also private home nurses may be informal and unregulated. In order to find a professional nurse for care at

home, clients must refer to the College of nurses (Ipasvi) to obtain a list of which professionals to contact (all

enrolled on the Public Register of Nurses).

There are concerns with the integration of social and home health care services. Only in some regions (mainly

in the Centre-North of Italy) are there agreements between Municipalities and Local Health Authorities for an

integrated provision (ADI) (Pesaresi 2007a, 2010).

Table 2 shows the coverage, in percentage, of all the at-home sanitary services for the elderly and the at-

home social assistance services (SAD) for all the people who are over 65 years of age.

Region 2005 2012 Number of hours per user per year 65+ 2012

Piemonte 1,8 2,1 15

Valle d’Aosta 0,1 0,4 37

Liguria 3,2 3,5 28

Lombardia 3,3 3,9 18

Trentino Alto Adige 0,6 2,0 n.d.

P.A. Bolzano 0,3 0,4 n.d

P.A. Trento 0,8 3,5 13

Veneto 5,0 5,5 10

Friuli Venezia Giulia 8,0 6,2 6

Emilia Romagna 5,4 11,8 18

Toscana 2,1 2,0 22

Umbria 4,2 7,9 22

Marche 3,4 3,0 25

Lazio 3,3 4,1 21

Abruzzo 1,8 4,9 34

Molise 6,1 3,9 81

Campania 1,4 2,8 29

Puglia 2,0 2,2 37

Basilicata 3,9 5,4 43

Calabria 1,6 3,1 20

Sicilia 0,8 3,6 30

Sardegna 1,1 4,6 36

Italia 2,9 4,3 21 Table 2: Homecare assistance coverage (percentage) for over 65 year old people [ISTAT, 2015; Ministry of Health, 2015]

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Regione 2005 2012 Average expenditure per user 65+ - 2012

Piemonte 1,4 -0,6 1.281

Valle d’Aosta 2,4 2,9 4.626

Liguria 1,2 -0,1 1.880

Lombardia 1,7 -0,3 1.919

Trentino Alto Adige 3,5 0,8 3.170

P.A. Bolzano 3,9 0,9 3.013

P.A. Trento 3,2 0,7 3.340

Veneto 1,7 -0,3 1.184

Friuli Venezia Giulia 2,6 -0,3 2.096

Emilia Romagna 1,9 -0,5 1.868

Toscana 1,2 -0,5 2.704

Umbria 0,6 -0,3 2.112

Marche 0,9 -0,2 2.701

Lazio 1,2 -0,3 3.140

Abruzzo 2,6 -1,3 1.796

Molise 3,9 -1,9 1.119

Campania 1,6 -0,5 1.928

Puglia 0,8 -0,1 2.583

Basilicata 1,5 -0,2 2.177

Calabria 1,0 = 1.153

Sicilia 2,7 -0,1 1.701

Sardegna 2,5 = 3.342

Italia 1,6 -0,3 2.090 Table 3: Homecare assistance coverage (percentage) for over 65 year old people [ISTAT, 2015]

8.1.2 Health homecare and home nursing

The Ministry of Health develops the national legislation, national minimum standards and the criteria for using

the National Health Fund. The National Health Service is financed by 95% through direct taxation (on income)

and indirect taxation (on consumption). The National Health Fund (NHF) is divided among Regions and Local

Health Authorities. The remaining costs are covered by revenues of Local Health Authorities and client co-

payment.

The National Health Service guarantees to people that are not self-sufficient and are experiencing some

difficulties and are sick or suffering from the consequences of a disease services and assistance at their

homes. This services are called house care and they consist of a series of medical treatments to help the

people involved in improving their life conditions.

These homecare treatments are integrated with the social assistance services and the support of the family of

the patient. They are generally granted by the Municipality where the person lives, after the completion of a

procedure to check on the situation of the person in order to establish a socio-sanitary integrated project

called ‘individual assistance project’ (IAP)

The Region is responsible for planning and implementing services through the local health units. It is also in

charge of defining the main organizational and managerial features of services, including control and

supervision; also plans and organizes the professional training of the care personnel.

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The relevant legislation is the first Prime Ministerial Decree (Decree of the President of the Council of

Ministers) of 29.11.2001 "" New territorial characterization home care and hospice work at home and in the

Ministerial Decree of 17 December 2008 "Establishment of the information system the home care monitoring

"The document “New definition of home nursing” in 2006 defined and updated the Essential Levels of health

Assistance (LEA) [Ministry of Health, 2007], stating three categories of home nursing care: occasional,

integrated and palliative.

1. Occasional homecare assistance: it is generally occasional but it can also be on a regular basis. A professional qualification is required for the staff that provides the assistance, in order to fulfill a specific medical need that does not require a multidisciplinary care plan. It is requested by the Doctor who is in charge of the patient and it is meant to fulfil a simple healthcare need for those patients that are not able to reach the outpatient services.

2. First and second level integrated homecare assistance: it is meant for those people that do not suffer

from any serious disease but need constant assistance either for 5 (1st level) or 6 days (2nd level). The General Practitioner plays a central role at this stage. He is responsible for the healthcare procedures. The range of the medical services that are granted involves: medical, nursing, rehabilitation, social and welfare services. These services are part of a patient’s customized project that is the result of a multi-level evaluation process.

3. Third level integrated homecare treatments and homecare palliative treatments for terminally ill patients that need non-stop high-level assistance and highly qualified staff. These treatments are for:

• Terminally ill patients (cancer-related or not);

• Patients who suffer from neurological and degenerative or progressive degenerative diseases such as ALS or muscular dystrophy ;

• Patients who need either artificial or parenteral nutrition or nutrition through a feeding tube;

• Patients who need mechanical ventilation;

• Patients in a permanent vegetative condition in a minimally consciuos state

• Advanced and complicated stages of chronical diseases

The document defines uniform eligibility criteria. Home nursing is needs-tested. The availability of informal

carers is also taken into account. These services are free of charge for people with minimum income and aged

over 65, and also for those with recognized chronic disabling diseases, for terminal cancer patients and during

an intensive post-acute phase (protected discharge from hospital). Otherwise a ticket for co-payment is

requested [Ministry of Health, 2010].

The national legislation must be implemented by the regional legislation through specific resolutions.

Therefore each region has its own specific legislation.

The indications set by the Administrative Law issued on the 29th November 2011 stem from the indications

contained in the decree issued by the Regional council on the 20th March 2007 that establish the basic levels

of homecare assistance and define the following aims to be reached by the Integrated System of homecare

assistance in Liguria:

• To provide adequate care to the people that have specific problems and are in need of homecare

assistance in order to avoid any extra hospitalization or admissions to a nursing home

• To help those people who are no longer able to take care of themselves in order to let them live in

their homes and help them to preserve their independence even if it is significantly reduced.

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• To quickly discharge people from hospitals providing them with the assistance they may need in their

homes.

• To help caregivers get the necessary training in order to give them the competences they need to carry

out their duties independently.

• To improve the quality of life of those people that are no longer self- sufficient or are likely to lose

their independence, in order to preserve the little independence they may have left.

Homecare assistance is a kind of service that is part of the Essential Levels of Assistance System that

guarantees the appropriate assistance to patients in whichever situation they may be, even the most difficult

ones, or when they are either old or seriously sick or no longer self - sufficient. The request for any homecare

treatment must be approved by the General Practitioner that must fill in an evaluation form about all the

needs that the patient may have. Then the service schedules a visit to the patient in order to check his/her

needs and the GP elaborates a customized assistance plan so the patient will be assisted by several members

of the medical staff such as: doctors, nurses, physiotherapists, careers, specialists in order to reach all the

goals set in the customized assistance plan.

Table 4 reports data related to homecare treatments (PIC) in 2015 in Liguria (by Local Health Authorities) and

Table 5 reports the public homecare treatments (PIC) in Italy.

Asl Code Asl description

Cases Patients over 65 Population over 65

101 IMPERIESE 3217 2.571 59562

102 SAVONESE 4417 3.116 80656

103 GENOVESE 8112 5.977 201477

104 CHIAVARESE 1886 1.268 41971

105 SPEZZINO 3446 2.466 59662

TOTAL 21078 15.398 443328

Table 4: public homecare treatments (PIC) in Liguria divided into the different Local Health Authorities in 2015

Region Code Region Pic activated that must end in 2015

Issued pic that end in 2015

010 Piemonte 32911 27581

020 Valle d'Aosta 89 73

030 Lombardia 43775 42542

041 P.A. Bolzano 0 0

042 P.A. Trento 2683 1939

050 Veneto 4614 4582

060 Friuli-Venezia Giulia 4261 3678

070 Liguria 13433 12679

080 Emilia-Romagna 45183 45183

090 Toscana 27480 20364

100 Umbria 3028 2863

110 Marche 4797 4308

120 Lazio 0 0

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130 Abruzzo 4856 4516

140 Molise 2352 1991

150 Campania 0 0

160 Puglia 19919 17345

170 Basilicata 567 160

180 Calabria 3517 2867

190 Sicilia 1324 649

200 Sardegna 0 0

TOTAL 214789 193320

Table 5: public homecare cases in Italy divided by region in 2015 (PIC)

The main HHCPs (Home Health Care Practitioners) who are involved in Health Homecare in Italy are:

• NURSES. In Italy there’s no specialization for nurses involved in homecare. After a three-year academic

degree (EQF6), compliant with the “European agreement on the instruction and education of nurses”,

Strasbourg, 25 October 1967 [Foreign and Commonwealth Office]2, nurses can provide public and

private home nursing to older adults.

• PHYSIOTHERAPISTS. Physiotherapist is identified by Italian law as one of the health professions for

rehabilitation. After a three-year academic degree (EQF6), physiotherapists can provide public and

private homecare to older adults.

• PSYCHOLOGISTS. In Italy there’s no specialization for psychologist involved in homecare.

• PROFESSIONAL EDUCATOR. Professional Educators are health care professionals specialized in

rehabilitation. Their work activities contribute to specific projects in the fields of education and

rehabilitation to promote a balanced development, rehabilitation and social reintegration of

physically or psychologically disadvantaged individuals, or people who are at risk of being socially

marginalized.

• OCCUPATIONAL THERAPIST. Occupational therapists are identified by Italian law as one of the health

professions for rehabilitation. After a three-year academic degree (EQF6), they can provide public and

private homecare to older adults.

8.1.3 Home help

The homecare assistance in Italy is managed at a local level. The Ministry of Work and Social Policy develops

the national legislation, national minimum standards and the criteria for using the National Fund for Social

Polices. Regions are responsible for planning and implementing home help services through the municipalities,

monitor the implementation and the integration among the planned interventions (social and health services)

and define the criteria for the authorisation, accreditation and monitoring of residential structures. A

municipality define the local rules regarding the provision of home help, contract home help agencies, set

prices and reimburses home help agencies (or grants voucher directly to the clients).

Some regions (e.g. Lombardy) opted for other funding mechanisms and issued vouchers for entitled

individuals, that can only be used for purchasing of specific services provided by providers authorized

(accredited) by the public authority. Additionally, care allowances (by Municipalities or more rarely by Local

Health Authorities) are used to pay family members for informal care. The client is free to spend the allowance

as desired [Lamura & Principi, 2009].

2 The agreement has been ratified in Italy with the law 795 – November 15th 1973

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The homecare assistance in Italy called SAD started in the 70s and it was aimed at taking care of the elderly in

order to avoid their alienation from society. The first law that was issued to reform social services stated that

the only authority that may handle such matters is the local municipality together with other institutions that

work in the same area.

The services that are provided are articulated in three groups:

- services at the patient’s home,

- services at the day care centres

- meals delivered at the patient’s location

The main aim of this kind of assistance is to promote and support a good quality of life for all the people who

lost either permanently or temporarily their independence and let them live as long as possible in their homes

avoiding their admission to a nursing home.

As established by law n.328 in 2000 the local municipalities are in charge of all the assistance services for the

citizens and they can either manage them individually or together with other nearby authorities according to

the homecare assistance plans set by each region. Each local municipality checks the potential needs that

people may have together with other local authorities such as comunità montana (an association created in

the 70s in Italy that includes all the municipalities that are in the mountain areas and foothills) district

authorities, local healthcare authorities call ASL in Italy and other kinds of associations.

The Homecare Assistance Service (SAD) is a kind of service for people that are over 65 or for those people that

find themselves in a psychophysical condition very similar to the one that an old person may experience in

order to let them live in their house as long as possible.

This kind of assistance has a double aim: it helps those who are no longer self-sufficient in their daily activities

to stay and live in their homes in their usual social contest with the help of a social operator that goes to their

house to help them and therefore avoiding or delaying their admission to a nursing home. These activities

are related to:

- homecare assistance to help the elderly in their daily life

- the main services that are issued are linked to: personal care and hygiene, help in the daily running of

their home, do the laundry and organize it, prepare the meals and help them in simple activities;

- the homecare assistance service is therefore aimed at improving the general wellness of a person in

order to increase the number of the services that can be offered.

- To let the elderly live in their home safely as long as possible;

- keep or recover adequate levels of independence in order to avoid their admission to a nursing home;

- guarantee the cooperation with the National Healthcare Authority in order to offer an adequate

assistance both at a social and medical level.

- To plan all the activities linking the homecare assistance services with the other services and resources

in the territory;

- To improve and support the operators that help the elderly in order to guarantee a better quality of

life;

- To promote and support the quality of life of the people that are no longer able to manage their family

life;

- To improve the relationship between associations and charity organizations;

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- To take care of all the needs that the elderly may have and therefore set up proper plans to fill their

needs;

- To check the homecare assistance plan from time to time;

- The service is issued by the competent territorial services following a professional evaluation carried

out by the Municipality. The people that are interested in getting assistance can fill in a form to ask for

it. This form is available at the local municipality offices. They also request a medical record that must

be filled in by the General Practitioner. The service can also be requested by the social careers in order

to plan the discharge of the patients from the homecare treatment in case of some social problems

related to the patient may occur.

Here are some data related to 2011 released on the ISTAT website in 2014 www.istat.it. They describe the

number of users and the expenses faced per each patient. The data are divided according to the type of

expenditure or region.

ITEM OF EXPENDITURE Expenditures Users Average expense

per user

ACTIONS AND SERVICES

Home assistance Socio-Assistance and home assistance 345.478.102 169.580 2.037

Home assistance integrated with homecare services 68.182.920 75.347 905

Neighborhood services 8.731.668 12.484 699

Telecare 11.549.986 65.230 177

Voucher, treatment voucher, socio-sanitary voucher 100.343.429 62.956 1.594

Meals distribution and/or at-home laundry 29.991.163 41.815 717

Other 7.191.295 22.195 324

Home assistance total 571.468.563 - -

Support services Meals 2.596.241 4.095 634

Social transportation 23.613.668 125.711 188

Total of support services 26.209.909 - -

Total of actions anservices 740.081.530 - -

Table 6: Elderly sector: users, expenses and expenses per user per each at-home service. Total in Italy - ISTAT Data (http://www.istat.it) in 2011, released in 2014

ITEMS OF EXPENDITURE Expenditure Users Average expense

per user

ACTIONS AND SERVICES

Home assistance Home and social assistance 59.722.093 19.896 3.002

Home assistance integrated with socio-sanitary services 11.061.155 11.831 935

Neighborhood services 6.891.293 7.293 945

Telecare 5.669.643 17.890 317

Voucher, treatment voucher, socio-sanitary voucher 24.212.571 7.949 3.046

Meals distribution and/or at-home laundry 5.127.254 3.175 1.615

Other 850.000 3.979 214

Home assistance (Total) 113.534.009 - -

Support Services Meals 24.648 160 154

Social Transportation 5.019.316 20.415 246

Total number of Support Services issued 5.043.964 - -

Total number of actions and services 144.419.024 - -

Table 7: Elderly area: users, expenses and expenses per each users in the big municipalities (with a population of more than 250.000 inhabitants)per each at –home assistance service issued. ISTAT Data (http://www.istat.it) in 2011, released in 2014

REGIONS AND GEOGRAPHICAL ALLOCATION Users Expenditure Average

Expenditure per users

Piemonte 9.073 7.160.108 789

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REGIONS AND GEOGRAPHICAL ALLOCATION Users Expenditure Average

Expenditure per users

Valle d'Aosta/Vallée d’Aoste 130 819.103 6.301

Liguria 295 276.296 937

Lombardia 3.471 988.386 285

Trentino-Alto Adige/Südtirol 442 1.177.544 2.664

Bolzano/Bozen - - -

Trento 442 1.177.544 2.664

Veneto 39.025 16.490.246 423

Friuli - Venezia Giulia 541 1.939.530 3.585

Emilia - Romagna 5.121 6.501.993 1.270

Toscana 6.018 10.191.412 1.693

Umbria 1.695 1.323.374 781

Marche 441 1.165.598 2.643

Lazio 3.996 7.792.903 1.950

Abruzzo 659 1.486.874 2.256

Molise 9 17.109 1.901

Campania 1.878 5.015.867 2.671

Puglia 1.119 3.448.124 3.081

Basilicata 121 298.303 2.465

Calabria 494 388.135 786

Sicilia 542 998.005 1.841

Sardegna 277 704.010 2.542

Nord-ovest 12.969 9.243.893 713

Nord-est 45.129 26.109.313 579

Centro 12.150 20.473.287 1.685

Sud 4.280 10.654.412 2.489

Isole 819 1.702.015 2.078

ITALIA 75.347 68.182.920 905

Table 8: Home assistance integrated with sanitary services for the elderly: expenditure and average expenditure per user, region and geographical area – ISTAT Data (http://www.istat.it) in 2011, released in 2014

REGIONS E GEOGRAPHICAL ALLOCATION Municipalities covered by the

service (percentage) Territorial coverage index for

the service (for 100 people)

Marker that indicates the amount of users who have been taken on

(per 100 people)

Piemonte 96,2 97,9 0,9

Valle d'Aosta/Vallée d’Aoste 83,8 90,1 5,2

Liguria 98,3 99,2 1,1

Lombardia 86,2 94,2 1,6

Trentino-Alto Adige/Südtirol 100,0 100,0 4,0

Bolzano-Bozen (e) …. …. 4,8

Trento 100,0 100,0 3,3

Veneto 94,0 97,2 1,4

Friuli - Venezia Giulia 100,0 100,0 2,3

Emilia - Romagna 88,2 91,4 1,6

Toscana 94,1 89,4 0,8

Umbria 85,9 75,5 0,3

Marche 79,5 87,9 0,7

Lazio 79,6 86,6 0,9

Abruzzo 96,1 90,9 1,6

Molise 73,5 80,2 2,2

Campania 89,1 71,8 1,2

Puglia 86,4 87,9 1,2

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REGIONS E GEOGRAPHICAL ALLOCATION Municipalities covered by the

service (percentage) Territorial coverage index for

the service (for 100 people)


(per 100 people)

Basilicata 80,2 86,6 1,4

Calabria 42,1 58,9 1,1

Sicilia 77,7 86,2 1,8

Sardegna 92,3 94,1 2,5

Nord-ovest 91,0 95,9 1,4

Nord-est 94,4 95,3 1,8

Centro 84,3 86,8 0,8

Sud 77,3 77,7 1,3

Isole 84,9 88,2 2,0

ITALIA 87,1 89,3 1,4

Table 9: Home and social assistance for the elderly: territorial indicators ISTAT – Data in 2011 released in 2014 (http://www.istat.it)

REGIONS AND GEOGRAPHICAL ALLOCATION Users Expenditure Average expenditure per user

Piemonte 9.073 7.160.108 789

Valle d'Aosta/Vallée d’Aoste 130 819.103 6.301

Liguria 295 276.296 937

Lombardia 3.471 988.386 285

Trentino-Alto Adige/Südtirol 442 1.177.544 2.664

Bolzano/Bozen - - -

Trento 442 1.177.544 2.664

Veneto 39.025 16.490.246 423

Friuli - Venezia Giulia 541 1.939.530 3.585

Emilia - Romagna 5.121 6.501.993 1.270

Toscana 6.018 10.191.412 1.693

Umbria 1.695 1.323.374 781

Marche 441 1.165.598 2.643

Lazio 3.996 7.792.903 1.950

Abruzzo 659 1.486.874 2.256

Molise 9 17.109 1.901

Campania 1.878 5.015.867 2.671

Puglia 1.119 3.448.124 3.081

Basilicata 121 298.303 2.465

Calabria 494 388.135 786

Sicilia 542 998.005 1.841

Sardegna 277 704.010 2.542

Nord-ovest 12.969 9.243.893 713

Nord-est 45.129 26.109.313 579

Centro 12.150 20.473.287 1.685

Sud 4.280 10.654.412 2.489

Isole 819 1.702.015 2.078

ITALIA 75.347 68.182.920 905

Table 10: The home assistance integrated with sanitary services (in Italy called ADI ) for the elderly: users, expenditure and average expenditure per user, per region and geographical area ISTAT – Data (http://www.istat.it) in 2011, released in 2014

REGIONS AND GEOGRAPHICAL ALLOCATION Municipalities covered by

the service (percentage) Service territorial coverage

index (per 100 people)


(per 100 people)

Piemonte 93,4 92,7 0,7

Valle d'Aosta/Vallée d’Aoste 1,4 31,7 0,8

Liguria 91,9 95,4 0,6

Deliverable 2.1


REGIONS AND GEOGRAPHICAL ALLOCATION Municipalities covered by

the service (percentage) Service territorial coverage

index (per 100 people)


(per 100 people)

Lombardia 66,4 70,9 0,5

Trentino-Alto Adige/Südtirol 100,0 100,0 0,2

Trento 100,0 100,0 0,4

Veneto 92,1 94,4 2,7

Friuli - Venezia Giulia 48,6 47,7 0,7

Emilia - Romagna 40,2 41,0 0,3

Toscana 29,3 36,2 0,3

Umbria 14,1 6,4 -0

Marche 54,0 48,6 0,2

Lazio 11,4 5,2 -0

Abruzzo 21,3 23,6 0,2

Molise 3,7 4,0 -0

Campania 5,8 8,0 0,1

Puglia 13,6 23,2 0,1

Basilicata 41,2 48,6 0,3

Calabria 10,5 7,6 -0

Sicilia 42,6 39,3 0,5

Sardegna 7,7 13,7 0,1

Nord-ovest 77,4 80,1 0,6

Nord-est 73,2 66,6 1,3

Centro 27,0 21,8 0,1

Sud 13,1 16,0 0,1

Isole 25,4 32,7 0,4

ITALIA 51,0 46,9 0,5

Table 11: Voucher, treatment voucher and socio-sanitary vouchers for the elderly: territorial indicators – ISTAT DATA in 2011 . (http://www.istat.it), released in 2014

The main HHCPs (Home Health Care Practitioners) who are involved in Social Homecare in Italy are:

• SOCIAL-HEALTH OPERATOR. A social-health operator is a qualified professional whose job description

centres on meeting the main needs of a patient, in a social or health care setting, by promoting the

patient’s autonomy and welfare. This new figure was introduced by The State-Regions Conference of

22nd February 2001

• HOMECARE ASSISTANT / HOME HELPER. The Homecare Assistant is the main figure who provides

social homecare / home aid to older adults.

• SOCIAL CARERS. In Italy regions manages autonomously social services and in particular interventions

for older adults in community. In some regions, specific figures manages services aimed at fostering

older adults independent living, monitoring situations of fragility and empowering mental, physical

and relational resources of the individual. This figure, who often attend a short course for being

qualified, takes different names in different regions. In this report is presented the figure identified by

Regione Liguria, the SOCIAL GUARDIAN.

8.1.4 Private health and social homecare

The homecare assistance is a very important service in Italy but it is difficult to define with exception to those

services that are outsourced by the local municipality authorities to other healthcare services according to law.

Many families in Italy turn to homecare private assistance and they often do so illegally so it is extremely

difficult to know the exact figures on this matter. We need to remember that often incentives are granted to

the people that need them but it is still difficult to take account of the exact amount.

Deliverable 2.1


As far as the home nursing is concerned we can say that about 9 million Italians pay to have a nurse in their

homes. We can say that 8.7 million people turned to a private nurse in a year (17,2% of adult people)

especially those who suffer from chronic diseases (2.8 million people) or those who are no longer self-

sufficient. The majority of these people live in the North of Italy (25.8 %), while in the North East of Italy the

percentage drops to 11.7%, 15.5% in the Centre and 15.4 in the South [Colicelli, 2015].

Based on the data collected by Censis (Centre for Social Investment Studies (www.censis.it), private spending

on nursing care amounted to a total of 2.7 billion euro. The majority of the requested services were:

injections (58.4%), perfusions, infusions and intravenous feeding (33.1%), general assistance (24.5%)

medications and bandaging (24.4%) and night assistance (22.8%). 54% of this kind of assistance is unreported

employment: 45% is completely unreported, 9% just for a small part. The economic crisis enables unreported

employment because people can spend less. Everybody (40.7%) thinks that the nurses do not work with a

regular contract because if they do so they must pay lots of taxes and therefore they can have less expenses

(40.5%) and the patients can save some money. [Colicelli, 2015].

The demand for nursing assistance is even bigger because in Italy 0.1 people suffer from chronic disease, 5.6

million of them are old people and 3.1 million are no longer self-sufficient (1.5 million of them are no longer

self-sufficient in a serious manner )

4.2 million people turned to non-medical staff to ask for assistance in 2015. We usually turn to family carers

(‘badanti’) or socio-sanitary operators for several reasons: because it is a reliable person that we know (42%)

or because a professional nurse is too expensive (33.7%) and because people think that in many cases it not

necessary to hire a nurse (31.5%) [Colicelli, 2015].

When family members take care of another member of the family who is no longer self - sufficient he/she

takes care of all the medical needs this person may have such as pharmacological therapies (88.8%), giving

injections (32.3%), bandaging and other medicaments (30.4%) and he/she is able to help whenever medical

assistance is requested and deals with the catheter (6.2%).

51.5% of the people that can get assistance from a family member believe that he /she can also perform

nursing duties and 30.6% believes he/she is able to intervene in case of an emergency. For 50.9 % of Italians (

55.4 % among the elderly , who most need nursing care ) there are simple performances to be carried out

such as injections or medications and therefore a nurse is not essential. This can result in inadequate

performance and the risk related to a performance not carried out by professionals [Colicelli , 2015].

More than 2 million families ( 2.143.000 people) asked for monetary help to pay medical staff who most of

the time (91%) has not been funded by social authorities. Moreover we need to take into account all those

families that despite being in need do not ask for any help most of the time because they do not have the

money to pay for it (12%, 2.9 million people). A family that needs full-time assistance (54 hours per week)

needs to pay from 1.150 to 1.860 euros per month. [Merotta, 2016]. More than half of all the people working

as a medical assistant in Italy were not Italian citizens in 2014: 459.000 out of 900.000. They are mainly women

(81%) between 30 and 49 years old and they mainly come from: Ukraine (81%), Philippines (16%), Moldavia

(11%) Peru (7%) and Sri Lanka (6%).

They are mostly located in the North (36%) and the center (27%) of Italy, while in the North West and in the

South the percentage significantly drops to 11% and 4% respectively.

Deliverable 2.1


Domestic workers are mainly located in North West (36%) and in the centre (27%) of Italy where most people

work full-time while in the North East they drop to 21%, to 11% in the South and 4% in the Islands where

people have a kind of lifestyle that allows that. [IRS-Soleterre, 2015].

Most domestic workers take care of people that are over 75 years of age. Most of them live with the patient or

with his family. Therefore domestic workers also get board and lodging. The patient often lives in a house that

is too big for him/her and so to give domestic workers board and lodging is not an additional cost. Therefore

this is the kind of assistance that is mostly requested by families, but sometimes they also ask for help just for

a couple of hours or during the nighttime [Merotta, 2016].

There are many agencies to recruit domestic workers in Italy. Some of them demand domestic workers to have

the ASA certification that certifies that a person is actually a domestic assistant or even the OSS certification

that certifies that a person is a socio - sanitary operator.

The regions and the local municipalities try to fight the unreported work phenomenon. The Ligurian region

set a register for domestic workers in 2016 in order to define the workers profile and fix the balance between

supply and demand, regulate the market and increase professionality. All the vouchers that the region will

issue will be granted to the people that will hire registered workers.

8.2 Homecare for older people with disabilities in Italy

8.2.1 Legislation and recommendations on home care for persons with disability in Italy

MINISTERIAL ACT:

• DPCM 29/11/2001 LEA (BASIC ASSISTANCE LEVEL)

REGIONAL LEGISLATION (Regione Liguria):

• Regional Committee Resolution N. 337/2007 – Regional Basic Assistance level

• Regional Committee Resolution N 446/2015 - Health and Social Services Integrated System

• PSIR 2013/2015 (Health and Social Services Regional Integrated System)

• Regional Law 12/20065

• Regional Law 41/2006

8.2.2 Responsibilities: Who is responsible for homecare (public/private sector, voluntary etc),

who organize homecare?

Homecare depends on public sector. The organization refers to health and social integrated system.

Shown below how local levels work and the specific function they have:

HEALTH AND SOCIAL DISTRICT is composed of:

1. HEALTH DISTRICT: health functions managed by Local Health Unit (Azienda Sanitaria Locale)

2. HEALTH AND SOCIAL AREA (District Unit; District Committee; health and social integrated Team): This

area submits both health discrict and social disctrict. Local Health Unit and Municipality sign

procedures in order to perform health and social functions. Different subjects are involved, disabled

people too

3. SOCIAL DISTRICT: Social functions are managed by municipality

8.2.3 Actors in disabled people home care

• Social district manager

• Welfare worker

• Health and social integrated area coordinator

Deliverable 2.1


• Educator and social animator

• Health care assistant or patient care assistant helps the patient move around, cleans patient, makes

bed etc, no sticks, may take vitals, may administer drugs if prepared by a nurse

• Family carer supports people doing chores, about personal care, prepares meals and stimulates

interests and socialization

• Psychologist

8.2.4 Access and care delivery process

Access channel to health and social services network and person with a disability care process:

� In social district, in health district, in local health services for person with disability. Each access point is

organized to meet people’s needs and manage it in an integrated manner

� Health and social integrated team evaluates the family situation with the family doctor/pediatrician

collaboration

� Integrated team realizes a project that could be refers to other public services for people with

disability

� Integrated team supervises and evaluates the projects

� District team for people with disability guarantees the respect of the uniqueness of the mission

8.2.5 Access model

A Health and Social Integrated team for people with disability is organized by both health and social

coordinator and it works alongside family doctor/ pediatrician.

It is composed of local health unit staff, municipality staff, specialist concerning the specific disability, welfare

worker, health care assistant, educator, psychologist, recovery therapist.

It is necessary a care delivery process, needs assessments, individual assistance plan to subscribe the request.

This model can allow an appropriate course of action. The access channel is a computerized single contact

point.

8.2.6 The financing of homecare service for persons with disability

Health budget is an economic, professional and human resources unit of measurement, aimed at a good social

mode of operation as much as possible.

In the details health budget is composed of health and social interventions. Benefits for careers are included in

the health budget. Health budget could be provided both personal services and subsidy.

The “life plan” (school and work inclusion – semi residential and residential - socialization and recreation –

home care assistance) is a management tool able to realize social and health activities. It takes the form of an

economic framework for the promotion of individual habilitation pathways

Not self-sufficient and vulnerable people are the subjects of this kind of project.

The welfare and rehabilitation plan must be defined on the basis of the evaluation system VILMA FABER based

on ICF (CLASSIFICATION OF FUNCTIONING DISABILITY AND HEALTH) and supported by the bio-psycho-social

regional dossier (FABER).

Managing bodies and other accredited bodies are the network of health and social services components which

contributes with the public service to design and manage the supply system (horizontal subsidiarity); Health

Local Unit (ASL) and municipalities have the responsibility to refer people to suitable services and it has to look

over the budget.

Health budget could allow people with disability to remain in their own residence, to support independent

living schemes, at home instead of home family care.

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TYPOLOGY INDEPENDENT LIVING MEDIA AND SEVERE DISABILITY

VERY SERIOUS DISABILITY

LEGAL DISABILITY Benefits for carers NOT REQUEST

Benefits for carers REQUEST

I.A. ASSOCIATED TO DEPENDENT

ISEE (EQUIVALENT ECONOMIC STATUS INDICATOR)

UP TO 25,000 EURO UP TO 25,000 EURO NO LIMIT ISEE

COMPATIBILITY WITH RESID / SEMIRESID SERVICES

RESID AND SEMIRESID SERVICES IN LOW HEALTH INTENSITY

SEMIRESID SERVICES ON ANY HEALTH INTENSITY

NO COMPATIBILITY

MAX VALUE 1,200 EURO/ MONTH 500 EURO / MONTH 1.200 EURO / MONTH

As is clear from the table, the aim is to coordinate the economic system sustainability and people with serious

disabilities needs without taking in to account the Equivalent Economic Status Indicator (ISEE).

8.2.7 Disabled people homecare challenges in Italy

One of the most important challenges is to design different way of living. People with disability, according to

their own abilities, can experiment with independent living schemata, alone or in small groups, supervised by

qualified personnel, however inside the house, not necessarily in a home care. It’s important taking in to

account a specific training for the staff.

8.3 Report on questionnaires targeting Italian HHCPs

The on-line questionnaire has been distributed through different channels, e.g. to professional nurses though

the Regional Office of Health, to Physiotherapists though the National Association of Physiotherapists and so

on. 214 subjects completed the questionnaire but only 190 have carried out an older adult homecare activity

in the last 5 years.

The distribution of answering practitioners is represented in Figure 5.

Figure 5: HHCPs answering the questionnaire

Deliverable 2.1


The HHCPs distribution with respect to the contexts in which they perform their activities is represented in

Table 12. This table has been extracted for the more significant group of practitioner with respect to the

number of valid answers to the on-line questionnaire and interviews with end-users, i.e. Nurses,

Physiotherapists, Social Health Operator, Social Guardian and Home care assistant/helper. The average age of

the subjects seems to be homogenous between the categories, for this reason is not a relevant data for this

analysis (median value between 40 and 45 years old).

Nu

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Public institutional homecare provider 82,76% 27,14% 83,33% 10,00% 0,00%

Private homecare provider 17,24% 7,14% 16,67% 70,00% 50,00% Freelance professional activity 0,00% 44,29% 0,00% 0,00% 25,00%

Other 0,00% 21,43% 0,00% 20,00% 25,00% Table 12 Overview of the HCCPs italian context

8.3.1 QUESTIONNAIRE SESSION 1: ACTUAL ACTIVITY AS A PROFESSIONAL

This section of the questionnaire has been focuses on actual activities as a professional in homecare, i.e. what

really happens when HHCPs provide their service at the older person’s own home.

8.3.1.1 Activities normally carry out at the older person’s home

Referring to the 5 selected Italian HHCPs, Figure 6 gives an overview about the activities normally carried out

at the older person’s home.

It is simple to highlight that all the figures reported equally that they perform the “evaluation of customer

needs” and mainly the “Home Environment assessment” and the “evaluation of health condition”.

It is also clear that, as expected, the activities closely related to the therapy are mainly performed by higher

specialized figures (as nurses and physiotherapists) as well as the daily activities to support the old persons

independence and their relationships (for details see the questionnaire Annex XXXX) are mainly performed by

the other Italian HHCPs

This result is also in line with the time each practitioners spend in the older person’s home, for example the

companionship activity is mainly performed by Social Guardians and by the Home Care Assistant that have an

average time spent in the houses longer than 1 our (see Figure 13).

Deliverable 2.1

Figure 6 Overview of the answers provided at question “Which of the following activities do you normally carry out at the older person’s home” by the five selected Italian professions

0,00% 100,00% 200,00% 300,00% 400,00%

evaluation of customer needs

evaluation of health condition

in-home health exams (e.g. taking blood sample)

personal assistance planning

companionship

support and assistance in social relationships

Home Environment assessment

intervention for a proper prescription and use of principals devices in home environment

education in health management and lifestyle

personal hygiene (bathing, grooming, etc.)

house management and cooking

Support to daily activities (shopping, going to a medical appointment, etc.)

prevention interventions

monitoring healthy lifestyle

pharmacological treatment and homeostasis maintenance, performance relating to excretory…

rehabilitation activities (walking, exercises, etc.)

positioning and supporting mobility

educational interventions for caregivers

team meeting and contacts with the other professionals involved in older person’s assistance

report of the activities conducted

Other

Nurse

Physiotherapist

OSS

Social Guardian

Deliverable 2.1


Figure 7 Nurses answers on activites carried out

0,00% 20,00% 40,00% 60,00% 80,00% 100,00%





companionship










pharmacological treatment and homeostasis maintenance, performance relating to excretory…






Other

Nurse

Deliverable 2.1


Figure 8 Phisioterapists answers on activites carried out

0,00% 20,00% 40,00% 60,00% 80,00% 100,00%





companionship










pharmacological treatment and homeostasis maintenance, performance relating to…






Other

Physiotherapist

Deliverable 2.1


Figure 9 Social health operator answers on activites carried out

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% 70,00% 80,00% 90,00% 100,00%





companionship
















Other

OSS - SOCIAL HEALTH OPERATOR

Deliverable 2.1


Figure 10 Social Guardian answers on activites carried out

0,00% 20,00% 40,00% 60,00% 80,00% 100,00%





companionship
















Other

Social Guardian

Deliverable 2.1


Figure 11 HomeCareAssistat/HomeHelper answers on activites carried out

0,00% 20,00% 40,00% 60,00% 80,00% 100,00%





companionship
















Other

Home Care Assistant /Home Helper

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8.3.1.2 Performed activities overview

The proposed question aims to identify for each practitioner which needs, from a list of 31 items, they

normally address in their daily activity. The comparison between the main Italian practitioner answers is

proposed in Figure 12.

For each selected professions we highlight in specific paragraph the activities selected with a percentage

higher than 70% by the subjects answering the questionnaire, and the those identified by a percentage of

selection lower of 10%.

NURSES

Figure 7 reports all the answers of nurses, in tables here below are reported the activities performed only occasionally (Table 13) or more frequently (Table 14): Need of basic maintenance of household appliances and the ones of personal use, including protection and

security review tasks of housing (ventilation, gas, electricity ...).

1,15%

Need of support and assistance in food management including preparation meals and purchase of foods. 2,30%

Need for a proper maintenance of the house including cleaning and order washing, ironing and

organization of the clothes inside the home.

3,45%

Need of support in mobility out of home . 4,60%

Table 13 Old persons’ needs less selected by Nurses as covered by their activity with the related percentage of selection

Need for protection of user privacy and intimacy . 73,56%

Need to a respectful treatment according to his/her dignity. 77,01%

Need of technical support with external devices: Oxygen, NIMV (non-invasive mechanical ventilation), feed

pumps, infusion pumps, home peritoneal dialysis, etc ...

78,16%

Need to be informed about your state of health and the available treatment and care options 78,16%

Specific care of urinary and fecal incontinence. 79,31%

Need to be supported and educated in proper positioning and postural changes to prevent physical

disorders.

80,46%

Prevention of skin lesions through proper hygiene, postural changes and specific skin care. 88,51%

Table 14 Old persons’ needs more selected by Nurses as those covered by their professionalo activity and the related percentage

PHYSIOTERAPISTS

Figure 8 reports all the percentage distribution of physiotherapist’s answers, in tables below are reported the

needs nor selected as those covered by their activities (Table 15) and those more frequently recognized as

covered (Table 16):

Need for a proper maintenance of the house including cleaning and order washing, ironing and organization

of the clothes inside the home

0,00%

Need of support and assistance in food management including preparation meals and purchase of foods 0,00%

Need of Support in adherence to treatment including preparing medication, reviewing medication

consumpion.

0,00%

Need of support or interventions in managing meals in case of eating disorder or malnutrition 1,43%


Need of support and assistance to accomplish administrative procedures including those relating with

health.

2,86%

Need to be supported in hygiene including shower or bath or oral hygiene 4,29%

Deliverable 2.1


Need of basic maintenance of household appliances and the ones of personal use, including protection and


4,29%

Need of support for the management of technological devices for home health monitoring 7,14%



8,57%

Table 15 Old persons’ needs less selected by Physiotherapists as covered by their activity with the related percentage of selection

Need to a respectful treatment according to his/her dignity 70,00%

Need of assistance for transfers and mobilization at home 71,43%


Need to feel safe and secure in his/her surroundings including suitability of the home to prevent "static

causes "of falls (assistance in removing barriers and adaptation of the home).

88,57%

Need to be supported and educated in proper positioning and postural changes to prevent physical disorders 92,86%

Table 16 Old persons’ needs more selected by Physiotherapists as those covered by their professionalo activity and the related percentage

OSS- SOCIAL HEALTH OPERATOR

Figure 9 reports all the percentage distribution of OSS answers, here below are reported the activities not

required by this practitioner category:

Need of basic maintenance of household appliances and the ones of personal use, including protection and


0,00%




8,33%

and the activities typical for this practitioner with the related percentage of selection:



Need to feel a deep respect regarding values (including religious beliefs and spiritual needs) 75,00%



Need of support and rehabilitation in toilet habits. 83,33%

Need for protection of user privacy and intimacy. 83,33%

SOCIAL GUARDIAN

Figure 10 reports all the social guardian answers, here below are reported the activities not required by this

practitioner category:



0,00%





and the most performed activities:

Deliverable 2.1



health.

70,00%

Need of protection and promotion of the psychological and emotional welfare and protection 70,00%

Need to be self-determined and independent. 80,00%



Need of support in mobility out of home 90,00%

Need of assistance to avoid situations of loneliness and isolation and facilitate family and social relations or

participation.

90,00%

HOME CARE ASSISTANT /HOME HELPER

Figure 11Figure 10 reports all the homecare assistant selection in percentage with respect to the activity they

perform in the old adults, here below are reported the activities not required by this practitioner category:

Need of basic maintenance of household appliances and the ones of personal use, including protection

and security review tasks of housing (ventilation, gas, electricity ...).

0,00%



consumpion.

0,00%

Need of support and assistance for effective communication. 0,00%

Need of support and rehabilitation of cognitive abilities (memory, attention, orientation etc.) 0,00%

Need of technical support with external devices: Oxygen, NIMV (non-invasive mechanical ventilation),

feed pumps, infusion pumps, home peritoneal dialysis, etc ...

0,00%

Need for protection of user privacy and intimacy 0,00%

and the most performed activities:

Need of assistance for dressing up and undressing 75,00%


Need of support and assistance in food management including preparation meals and purchase of foods 75,00%



Need for a proper maintenance of the house including cleaning and order washing, ironing and

organization of the clothes inside the home

100,00%

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Figure 12 Compared overview of the answers provided by participant to the question on needs addressed by their professional activity.

Deliverable 2.1

8.3.1.3 Frequency of visits and time spent at the older person’s home

The HHCPs has a similar frequency in visiting the old adult at home (Figure 14 How many times on average do you

visit the same older person’s in a week) 2-3 times per week, instead the average time spent in the houses depends

to their professional activities. Looking at Figure 13 it seems that the practitioners that carried out more

clinical activities have a maximum of 1 hour instead the figure that mainly support old adults in daily activities

have an higher average time.

Figure 13 What is the average time ACTUALLY spent at the older person’s home in your daily activity

Figure 14 How many times on average do you visit the same older person’s in a week

8.3.1.4 Professional competencies required by homecare

In the question regarding skills and competences needed in home cares participant were asked to provide

information about which competences are required in their work and at which level, in their opinion, they

mastery them. They were also asked to indicate how they acquired the competences (education of practicing)

A list of 42 competences has been proposed to the responders.

To present results of Italian responders we highlight first the list of competences with the percentage of

practitioner answering as required skills (Table 17 List of proposed competences and the related percentage of answers to

the question about their requirement.), in light orange are highlighted the competences identify as “not required” by

0,00%

10,00%

20,00%

30,00%

40,00%

50,00%

60,00%

70,00%

80,00%

90,00%

100,00%

Up to 15minutes

From 15 to 30minutes

From 30 minto 1 hour

From 1 to 2hours

From 2 to 4hours

From 4 to 8hours

Other

Nurse

Phisioterapist

OSS

Social Guardian

home care assistant /home helper

0,00%

10,00%

20,00%

30,00%

40,00%

50,00%

60,00%

70,00%

80,00%

90,00%

100,00%

Once From 2 to 3times

From 3 to 5times

From 5 to 7times

More than 7times

Nurse

Phisioterapist

OSS

Social Guardian

Deliverable 2.1


the majority of all the 5 type of Italian practitioners, in the same way in light green are highlighted the item

recognized as “required”. All the answers are reported in ANNEX XX .

IS THE COMPETENCE

REQUIRED? Nu

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Basic knowledge in medical assistance

Required (A2) 86,21% 74,29% 25,00% 20,00% 0,00%

Not Required (A1) 12,64% 24,29% 75,00% 80,00% 100,00%

No answers 1,15% 1,43% 0,00% 0,00% 0,00%

Basic medical knowledge specifically related to my profession

Required (A2) 95,40% 84,29% 41,67% 10,00% 0,00%

Not Required (A1) 3,45% 14,29% 58,33% 90,00% 75,00%

No answers 1,15% 1,43% 0,00% 0,00% 25,00%

Basics in anatomy and pathology

Required (A2) 96,55% 94,29% 50,00% 10,00% 0,00%

Not Required (A1) 3,45% 5,71% 41,67% 90,00% 100,00%

No answers 0,00% 0,00% 8,33% 0,00% 0,00%

Environmental and personal hygiene basic concepts

Required (A2) 91,95% 78,57% 75,00% 50,00% 75,00%

Not Required (A1) 6,90% 21,43% 25,00% 50,00% 25,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Basics in home economics

Required (A2) 18,39% 14,29% 33,33% 30,00% 75,00%

Not Required (A1) 79,31% 82,86% 66,67% 70,00% 25,00%

No answers 2,30% 2,86% 0,00% 0,00% 0,00%

Basics in dietetic

Required (A2) 80,46% 42,86% 58,33% 10,00% 0,00%

Not Required (A1) 17,24% 57,14% 41,67% 90,00% 100,00%

No answers 2,30% 0,00% 0,00% 0,00% 0,00%

Basics in older person’s healthy lifestyles

Required (A2) 91,95% 94,29% 75,00% 80,00% 75,00%

Not Required (A1) 6,90% 5,71% 25,00% 20,00% 25,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Basic psychology elements

Required (A2) 81,61% 87,14% 66,67% 50,00% 25,00%

Not Required (A1) 16,09% 12,86% 33,33% 50,00% 75,00%

No answers 2,30% 0,00% 0,00% 0,00% 0,00%

Basics in domestic safety and prevention

Required (A2) 66,67% 75,71% 66,67% 30,00% 50,00%

Not Required (A1) 32,18% 24,29% 33,33% 70,00% 50,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Basics in social-health services organizations and networks

Required (A2) 86,21% 75,71% 66,67% 80,00% 50,00%

Not Required (A1) 12,64% 24,29% 33,33% 20,00% 50,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Knowledge about the main aids and devices for older and disabled people

Required (A2) 93,10% 98,57% 83,33% 50,00% 50,00%

Not Required (A1) 6,90% 1,43% 16,67% 50,00% 50,00%

No answers 0,00% 0,00% 0,00% 0,00% 0,00%

Basic on the main characteristics of peoples with different levels of autonomy

Required (A2) 81,61% 82,86% 66,67% 20,00% 0,00%

Not Required (A1) 18,39% 14,29% 33,33% 80,00% 50,00%

No answers 0,00% 2,86% 0,00% 0,00% 50,00%

Basics in law and human rights frameworks

Required (A2) 57,47% 47,14% 50,00% 10,00% 0,00%

Not Required (A1) 41,38% 52,86% 41,67% 90,00% 100,00%

No answers 1,15% 0,00% 8,33% 0,00% 0,00%

Basic procedures in medical assistance (eg. make injection, provide drugs, change medications, etc.)

Required (A2) 94,25% 5,71% 25,00% 0,00% 0,00%

Not Required (A1) 5,75% 94,29% 66,67% 100,00% 100,00%

No answers 0,00% 0,00% 8,33% 0,00% 0,00%

Deliverable 2.1


Other specific basic medical procedures related to my profession

Required (A2) 90,80% 50,00% 16,67% 0,00% 0,00%

Not Required (A1) 5,75% 45,71% 83,33% 100,00% 100,00%

No answers 3,45% 4,29% 0,00% 0,00% 0,00%

Procedures for providing medical therapies

Required (A2) 90,80% 5,71% 8,33% 0,00% 0,00%

Not Required (A1) 8,05% 92,86% 83,33% 100,00% 100,00%

No answers 1,15% 1,43% 8,33% 0,00% 0,00%

Procedures for providing physical therapies

Required (A2) 44,83% 80,00% 0,00% 0,00% 0,00%

Not Required (A1) 52,87% 18,57% 100,00% 100,00% 100,00%

No answers 2,30% 1,43% 0,00% 0,00% 0,00%

Procedures for environmental hygiene

Required (A2) 51,72% 44,29% 50,00% 10,00% 50,00%

Not Required (A1) 44,83% 55,71% 50,00% 90,00% 50,00%

No answers 3,45% 0,00% 0,00% 0,00% 0,00%

Procedures for personal hygiene

Required (A2) 81,61% 27,14% 83,33% 10,00% 75,00%

Not Required (A1) 17,24% 72,86% 16,67% 90,00% 25,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Procedures for customer moving

Required (A2) 89,66% 98,57% 75,00% 10,00% 75,00%

Not Required (A1) 9,20% 1,43% 25,00% 90,00% 25,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Cooking

Required (A2) 5,75% 0,00% 16,67% 10,00% 50,00%

Not Required (A1) 93,10% 100,00% 75,00% 90,00% 50,00%

No answers 1,15% 0,00% 8,33% 0,00% 0,00%

Procedures for defining an eating plan

Required (A2) 33,33% 4,29% 16,67% 0,00% 0,00%

Not Required (A1) 64,37% 94,29% 83,33% 100,00% 100,00%

No answers 2,30% 1,43% 0,00% 0,00% 0,00%

Procedures for monitoring healthy lifestyles

Required (A2) 62,07% 48,57% 50,00% 60,00% 25,00%

Not Required (A1) 37,93% 51,43% 50,00% 40,00% 75,00%

No answers 0,00% 0,00% 0,00% 0,00% 0,00%

Managing errands

Required (A2) 3,45% 1,43% 25,00% 80,00% 50,00%

Not Required (A1) 94,25% 98,57% 75,00% 20,00% 50,00%

No answers 2,30% 0,00% 0,00% 0,00% 0,00%

Usage of reporting and monitoring tools

Required (A2) 63,22% 32,86% 33,33% 60,00% 0,00%

Not Required (A1) 35,63% 67,14% 66,67% 40,00% 100,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Procedures for fostering customers going out of home

Required (A2) 37,93% 64,29% 50,00% 50,00% 50,00%

Not Required (A1) 60,92% 35,71% 50,00% 50,00% 50,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Fostering customers social and familiar relations

Required (A2) 57,47% 41,43% 66,67% 60,00% 50,00%

Not Required (A1) 42,53% 58,57% 33,33% 40,00% 50,00%

No answers 0,00% 0,00% 0,00% 0,00% 0,00%

Using ICT for social participation

Required (A2) 26,44% 7,14% 41,67% 10,00% 0,00%

Not Required (A1) 73,56% 88,57% 58,33% 90,00% 100,00%

No answers 0,00% 4,29% 0,00% 0,00% 0,00%

Using ICT for health status monitoring

Required (A2) 49,43% 5,71% 25,00% 10,00% 0,00%

Not Required (A1) 50,57% 90,00% 66,67% 90,00% 100,00%

No answers 0,00% 4,29% 8,33% 0,00% 0,00%

Providing the customer with contextualized and personalized information about the network of services he/she can rely on

Required (A2) 75,86% 51,43% 75,00% 80,00% 0,00%

Not Required (A1) 24,14% 48,57% 25,00% 20,00% 50,00%

No answers 0,00% 0,00% 0,00% 0,00% 50,00%

Basic procedures in medical assistance (eg. make injection, provide drugs,

Required (A2) 97,70% 4,29% 16,67% 0,00% 0,00%

Not Required (A1) 2,30% 95,71% 75,00% 100,00% 100,00%

Deliverable 2.1


change medications, etc.) No answers 0,00% 0,00% 8,33% 0,00% 0,00%

Competences for caring with dignity

Required (A2) 83,91% 72,86% 75,00% 40,00% 50,00%

Not Required (A1) 16,09% 25,71% 25,00% 60,00% 25,00%

No answers 0,00% 1,43% 0,00% 0,00% 25,00%

Competences for managing conflicts

Required (A2) 44,83% 40,00% 41,67% 70,00% 25,00%

Not Required (A1) 54,02% 60,00% 58,33% 30,00% 75,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Competences for collaborating with other practitioners

Required (A2) 89,66% 88,57% 66,67% 100,00% 50,00%

Not Required (A1) 10,34% 11,43% 33,33% 0,00% 50,00%

No answers 0,00% 0,00% 0,00% 0,00% 0,00%

Competences for coordinating the work of other practitioners

Required (A2) 45,98% 38,57% 33,33% 10,00% 0,00%

Not Required (A1) 51,72% 61,43% 58,33% 90,00% 100,00%

No answers 2,30% 0,00% 8,33% 0,00% 0,00%

Competences for working in a group /equip /staff

Required (A2) 91,95% 88,57% 75,00% 60,00% 0,00%

Not Required (A1) 8,05% 11,43% 25,00% 40,00% 100,00%

No answers 0,00% 0,00% 0,00% 0,00% 0,00%

Competences for evaluating customer needs and adapting the service

Required (A2) 88,51% 82,86% 50,00% 70,00% 25,00%

Not Required (A1) 10,34% 17,14% 50,00% 30,00% 75,00%

No answers 1,15% 0,00% 0,00% 0,00% 0,00%

Competences for evaluating customer mental health status

Required (A2) 77,01% 57,14% 8,33% 40,00% 25,00%

Not Required (A1) 21,84% 42,86% 83,33% 50,00% 75,00%

No answers 1,15% 0,00% 8,33% 10,00% 0,00%

Competences for empowering the customer

Required (A2) 58,62% 44,29% 16,67% 50,00% 25,00%

Not Required (A1) 41,38% 55,71% 75,00% 50,00% 75,00%

No answers 0,00% 0,00% 8,33% 0,00% 0,00%

Grief support

Required (A2) 65,52% 24,29% 66,67% 50,00% 25,00%

Not Required (A1) 33,33% 72,86% 33,33% 50,00% 75,00%

No answers 1,15% 2,86% 0,00% 0,00% 0,00%

Competencies for terminal illness support

Required (A2) 83,91% 50,00% 50,00% 30,00% 50,00%

Not Required (A1) 16,09% 50,00% 41,67% 70,00% 50,00%

No answers 0,00% 0,00% 8,33% 0,00% 0,00%

Competencies for supporting the customer in building up an independent living path

Required (A2) 45,98% 55,71% 50,00% 50,00% 0,00%

Not Required (A1) 52,87% 42,86% 50,00% 50,00% 100,00%

No answers 1,15% 1,43% 0,00% 0,00% 0,00%

Table 17 List of proposed competences and the related percentage of answers to the question about their requirement.

Nurses and Physiotherapists indicated a majority of “required competences” with respect to those indicated as

“not required competences”. Instead the other three figures have identified a major number of item

recognized as “not required” for their specific activity (see Table 18 for an overview)

Competences

Nurses Physioterapists OSS Social

Guardian

Home Care

Assistant

Required 31 21 18 12 5

No required 11 20 19 22 24

Table 18 Practitioner identification of required /not required competences with respect to those presented in questionnaire

Responders evaluated also their ability in managing the competences and almost all the item recognized as

required has been declared managed with high mastery. The same competences have been acquired, by the

majority of the responders, both “attending a school, a training course or an academic course” then “working

practice”. Only few items have a different behavior in the answers trend.

Deliverable 2.1


Basic in dietetic has been recognize by OSS as a required competences but there is not a clear majority on how

they mastery this competence (25% low mastery and 25% mean mastery). The item Basics in social-health

services organizations and networks has been recognized as required competence by 4 type of Italian

practitioner with respect to the 5 selected for the analysis of primary data, but there is no an homogenous

perception of how they manage this competence for Nurses and Physioterapists (Table 19). The reason can be

found in the acquisition of this competence.

Competences Nurses Physioterapists OSS Social Guardian

Low Mastery 20,69% 24,29% 0,00% 0,00% Mean Mastery 32,18% 32,86% 25,00% 30,00%

High Mastery 34,48% 21,43% 50,00% 70,00%

Table 19 Overview of answers to how the practitioner master the competence “basic in social health services organizations and network”

The 44.83% of nurses acquired the competence during courses (with respect to a 33.33% that indicate not

during courses) but at the same time the 80.46% of nurses declare to have learned such competence by

working practice. Physiotherapists instead have a more structured answers to the acquisition of such

competence, the 60% declared to have not learned it at school (vs 14.09% of yes) and the 67,14% indicate the

working practice as competence acquisition method. For the same item we have a complete different

situation in the answers provided by the Social Guardians. The majority of this responders indicate to have a

high mastery of social-health services organizations and network competences at it has been acquired mainly

by working practice (80% of positive answers) and nor in official training courses.

Basics in law and human rights frameworks competence for Nurses has a medium/low level of mastery

(29,89% medium and 26,44 low) even if it has been acquired by the majority of the responders both at official

courses and working practice.

Social Guardians differences their answers from the general trend also for other 6 competences. Those

competences are recognized as required, but in all the cases the acquisition of these competences happens

mainly by working practice instead of school or courses. Table 20 gives an overview on the percentage of

positive answers to the questions 1.5 of the 6 competences.

Competences

Required

competence

Acquired by

working

practice

Acquired by

attending

courses…

Procedures for monitoring healthy

lifestyles 60% 70% 30%

Basics in older person’s healthy lifestyles 80% 90% 50% Managing errands 80% 70% 20%

Usage of reporting and monitoring tools 60% 60% 30%

Fostering customers social and familiar

relations 60% 70% 30%

Providing the customer with

contextualized and personalized

information about the network of

services he/she can rely on

80% 70% 30%

Table 20 Comparison between the answers of social guardians to the questions “is the competencies required to perform the activity”, “how do you master these competencies” and “how did you acquire these competences” for 5 Competences that hve been acquired mainly working practice.

Similar to such behavior on Social Guardians’ answers above described there is the Physiotherapists approach

to the Procedures for fostering customers going out of home and to Competences for caring with dignity. In

Deliverable 2.1


this case the competence is recognize to be a required competence acquired by working practice by the

64,29% of responders for the first item and 58.57% for the second, with respect to a 20% - 24% of them who

declared to have acquired such competence during formal training.

Basics in domestic safety and prevention is another item that present a discrepancy in the answers

distribution. It has been recognized as “not required competence” by the majority of the Social Guardians

responders (70%) at the same time the 60% of such figures declared a high level of mastery for this

competence, even if it has been acquired only working by practice.

8.3.1.5 Additional competencies required to perform the activities carry out by the practitioner

This question has been designed to give the possibility to integrate the previous list of competences with

specific items. The distribution in percentage of subject who identifies the need to integrate the list is

represented in Table 21.

There are

other

competences…?

Nurses Physiotherapists OSS Social

Guardian

Home Care

Assistant

YES 4,60% 15,71% 0,00% 10,00% 0,00%

NO 95,40% 84,29% 100,00% 90,00% 100,00%

Table 21 Answers to question “Are there other competencies that you think are required to perform the activities you actually carry out and to address the needs you actually target in addition to those listed below”

Even if from Table 18 Nurses and Physiotherapists have found a majority of required items, few of them

suggest other competences required for performing their activity; on contrary OSS, Social Guardian and Home

Care Assistant seems to be satisfied by the first list.

In the free text (question 1.6b) some of the Nurses and Physiotherapists involved in the questionnaire

suggested commonly as required competence on relating with familiars and other informal caregivers.

8.3.2 QUESTIONNAIRE SESSION 2: TARGETED NEEDS AND COMPETENCES IN AN IDEAL HOMECARE

This section of the questionnaire we will focus on an IDEAL situation, asking to responders to identify possible

further older persons’ needs to address and possible further competencies necessary to target them. In Table

22 there is the resume of the answers to the first question aiming to identify if there are additional needs

Nurses Physiotherapists OSS Social

Guardian

home care assistant

/

home helper

YES 9,20% 18,57% 33,33% 0,00% 0,00% NO 90,80% 81,43% 66,67% 100,00% 100,00%

Table 22 Answers to question “Do you think that there are some users’ needs that should be addressed by your activity AS SPECIFIC PROFESSIONAL in addition to those selected above”

Subjects answering positively to this question have the possibility to select, from a list of 31 needs, those that

can be fulfilled by their activity. Figure 15 gives the overview of such selection.

Few nurses have answered positively to the previous question, and this is coherent with the distribution of

positive answers with respect to the competences identified has required in the previous section (see Table

18). From the suggested needs provided, Table 23 represent the nurses choices selected with a greater

percentage.


Deliverable 2.1


Need of assistance to avoid situations of loneliness and isolation and facilitate family and

social relations or participation.

5,75%

Need of support in compliance with non pharmachological treatment including active and

health lifestyle such as prescribed diet, food intake control, physical excercises

5,75%

Table 23 Needs selected by nurses

Table 24 instead reasume the needs identified by Physiotherapists with a higher percentage as well as Table

25 reasume the OSS choises.



health.

5,71%


Need of assistance to avoid situations of loneliness and isolation and facilitate family and social

relations or participation.

11,43%

Need to be supported in the self-management of his/her physical health. 5,71%

Need to be supported in the self-management of his/her mental health 5,71%

Need to feel safe and secure in his/her surroundings including suitability of the home to prevent "static

causes "of falls (assistance in removing barriers and adaptation of the home).

7,14%

Need of support in compliance with non pharmachological treatment including active and health

lifestyle such as prescribed diet, food intake control, physical excercises

5,71%

Need of support and rehabilitation of cognitive abilities (memory, attention, orientation etc.) 5,71%

Need of technical support with external devices: Oxygen, NIMV (non-invasive mechanical ventilation),

feed pumps, infusion pumps, home peritoneal dialysis, etc ...

5,71%



Table 24 List of needs selected by Physiotherapists with an higher percentage


Need of basic maintenance of household appliances and the ones of personal use, including protection

and security review tasks of housing (ventilation, gas, electricity ...).

25,00%


health.

8,33%



Need of protection and promotion of the psychological and emotional welfare and protection 16,67%

Need of assistance to avoid situations of loneliness and isolation and facilitate family and social

relations or participation.

8,33%

Need to be supported in the self-management of his/her mental health 8,33%

Need to be supported and educated in proper positioning and postural changes to prevent physical

disorders

8,33%

Need to feel safe and secure in his/her surroundings including suitability of the home to prevent

"static causes "of falls (assistance in removing barriers and adaptation of the home).

8,33%


consumpion.

16,67%

Need of support or interventions in managing meals in case of eating disorder or malnutrition 16,67%

Need of support and assistance for effective communication. 8,33%


Table 25 List of needs selected by OSS with an higher percentage

Deliverable 2.1

Figure 15 Comparison between the practitioners selection of needs they currently don’t address but they perceive the need.

Deliverable 2.1


to the participants that identified the possibility to address further needs of the old people, were asked also to

indicate from a list of 42 competences (the same of question 1.5) which of them are necessary for addressing

such needs.

Nurses indicate almost all the competences as required. Instead physiotherapists identified with a clear majority

only 11 competences. The third Italian category of HHCPs, i.e. OSS, have not a clear opinion between required or

not required for 61.9% of the proposed competences ( i.e. distribution of 50% of the answers between required

and not required), instead for the others competences they clearly defined them as not required, Table 26

reassumes this aspect.

Competences Nurses Physiotherapists OSS

Required 39 11 0 No required 3 31 14 Not a defined majority 0 0 26

Table 26 Number of proposed competences selected by the majority of the responders as required or not required. When the distribution between the two asswers is 50% it has been counted as “not a defined majority”.

Also in this case the trend of answers of the Nurses is homogenous, the majority of them perceived the level of

how they master the competence Average or High level. The competences have been acquired attending a

school, training courses or academic courses and have been improved during working practice. The only

competence that deviates from this trend is the item Competencies for terminal illness support, for it there is

not a defined majority identifying if this competence has been acquired attending at courses or not (50% equally

distributed). More over this competence has no a clear majority on the question related to how they manage it,

in fact 25% answered low mastery, 25% answered average mastery, 37,5% answered high mastery and 12,5%

preferred to avoid answering.

In Table 27 are reported the 11 competences identified by physiotherapists as required as well as they level of

mastery and how they acquired them. In most of the cases the subjects preferred to not answering to the

questions related to how they manage the competence and on how they acquired them. The main reason can be

the fact that such competences have been declared to be required for satisfying additional needs to those

already covered by their activity. Subjects presenting an answer, for example, on how they master the

competences declare to have a high level of mastery.

Deliverable 2.1


COMPETENCE IS THE COMPETENCE

REQUIRED?

SELF-EVALUATE THE LEVEL

YOU MASTER THE

COMPETENCE

COMPETENCE ACQUIRED

ATTENDING A SCHOOL, A

TRAINING COURSE OR AN

ACADEMIC COURSE

COMPETENCE

ACQUIRED BY

WORKING PRACTICE


Required 53,85% No answer 53,85% No answer 53,85% No answer 69,23% NotRequired 46,15% Low Mastery 7,69% No 0,00% No 7,69% 0,00% Average Mastery 15,38% Yes 46,15% Yes 23,08% High Mastery 23,08%


Required 69,23% No answer 38,46% No answer 38,46% No answer 46,15% NotRequired 30,77% Low Mastery 0,00% No 0,00% No 23,08% Average Mastery 23,08% Yes 61,54% Yes 30,77% High Mastery 38,46%











Basic on the main characteristics of peoples with different levels of

autonomy


Deliverable 2.1



REQUIRED?


YOU MASTER THE

COMPETENCE

COMPETENCE ACQUIRED



ACADEMIC COURSE

COMPETENCE

ACQUIRED BY

WORKING PRACTICE







Table 27 Required additional competences identified by physiotherapists with the related level of mastery and how they acquired them.

The other two questions give the possibility to indicate other competences with respect to the presented list but in this case nobody declared that other

competences are required.

Deliverable 2.1


8.3.3 QUESTIONNAIRE SESSION 4: EVALUATION OF OLDER PERSONS’ NEEDS

The proposed questions are filtered in function on the answers to section 0 (see Table 12) so no all the

selected categories of Italian HHCPs has answered to all the questions.

All the selected category work for homecare provider and the majority of these responders normally

participate in the definition of the older person’s needs and participate in the definition of a personalized

homecare plan with the exception of Social Guardian.

The freelance practitioner of Physiotherapists and Social Guardian has declare that formalize in a sheet, a

chart or a report both the initial evaluation of older person’s need then the homecare plan. Instead the

freelance representatives of the Home Care Assistant declare to not formalize any evaluation of old adult or

homecare plan, as expected by their role.

All the 5 categories of Italian HHCPs normally evaluate in itinere elderly needs and, when possible, they refine

the homecare plan according to changing situations (85% in average). At the same time the practitioner

answered with a big majority (average of 81%) that they set their intervention, in the homecare plan, in a

more general personalized path for independent life and dignity, with proper competences following the

76.83% of responders.

8.3.4 QUESTIONNAIRE SESSION 5: ROLE OF THE HOMECARE PROVIDER ORGANIZATION IN THE

DELIVERY OF THE SERVICE

This part of the questionnaire is conditioned to the context of the practitioner as described in Table 12, in

particular only to whom working for an home care provider, either private or public.

The majority of HHCPs had detailed operative guidelines but in any case they perceived a good level of

autonomy with respect to such indications. Table 28 and Table 29 details the distribution of the answers.

Question no 5.1 A

Nurse Phisioterapist OSS Social Guardian

home care assistant / home helper

Yes 79,31% 58,33% 100,00% 87,50% 100,00%

No 20,69% 41,67% 0,00% 12,50% 0,00%

No answers 0,00% 0,00% 0,00% 0,00% 0,00% Table 28 Distribution of answers to the question “Does your organization provide you with detailed operative guidelines?”

Question No. 5.1. b Nurse Phisioterapist OSS

Social Guardian

home care assistant / home helper

1 (1) 0,00% 0,00% 25,00% 0,00% 0,00% 2 (2) 3,45% 0,00% 0,00% 0,00% 0,00% 3 (3) 18,39% 4,29% 33,33% 10,00% 25,00% 4 (4) 44,83% 12,86% 41,67% 40,00% 25,00% 5 (5) 12,64% 2,86% 0,00% 20,00% 0,00% Mean 3,84 3,93 2,92 4,14 3,5 Standard deviation 0,74 0,62 1,24 0,69 0,71

Table 29 Distribution of answers to the question “If yes, what is the level of your autonomy with respect to the guidelines? Please select a value from 1=no autonomy to 5=complete autonomy”

Deliverable 2.1


8.4 Report on interviews targeting older adults experiencing homecare in

Italy

The total number of older adults interviewed on the experience of homecare services are 28. 12 (43%) of

respondents answered in relation to the provision of homecare services from Homecare assistant, 9 (32%)

referred to the provision of a homecare services from Social guardian, 6 referring to the provision of a

homecare services from rehabilitation staff and 1 (4%) referring to the homecare services provided by an

educator(Figure 16. HHCP professionals whose older adults). The total No of subjects interviewed are 28, 9

men and 19 women All the subjects interviewed were over 65.

Figure 16. HHCP professionals whose older adults interview referring to.

Figure 17 Social guardian services reported by older adults show the profiles of the activities of the different

HHCP (social guardian, Homecare assistant and Rehabilitation staff) reported by older interviewed. The results

show that older adults receiving homecare services from Social Gaurdians report mainly activities related to:

support and assistance in social relationships (100%), companionship (88.9%) and support in the

implementation of activities of daily living (88.9%). Comparing the profile arising from these dat with the one

described by the Social guardian responding on the same question in the Questionnaire, we can appreciate

that there is a is a substantial matching between the perception of the 2 different point of view.

The most cited, by older adults, activities conducted by 'homecare assistant are management of the house

and preparing meals (91.6%), companionship (91.6%), personal hygiene support (91.6%)(Figure 18 Homecare

assistant services reported by older adults). Comparing activities profile of the Homecare assistant described

by older adults with the one described by the professions, we can appreciate that expect for the relevance of

the user needs, there is a substantial correspondence between the two different point of view. The activities

profile described by older adults receiving homecare services from rehabilitation staff include the following

most cited activities needs assessment (100%), companionship (100%) and evaluation of the health

conditions (83,3%).

32%

43%

4%

21%

Social guardian

Home careassistant/HomeHelperEducator

Rehabilitation staff

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Figure 17 Social guardian services reported by older adults

Figure 18 Homecare assistant services reported by older adults

0 10 20 30 40 50 60 70 80 90 100

1. evaluation of your needs

2. evaluation of your health condition

3.in-home health exams (e.g. taking blood sample)

4. personal assistance planning

5. companionship

6. support and assistance in social relationships

7. Home Environment assessment in terms of safety,…

8. Assistance in the prescription and use of principals tools…

9. education in health management and lifestyle

10. personal hygiene (bathing, grooming, etc.)

11. house management and cooking

12. Support to daily activities (shopping, going to a medical…

13. Illness prevention interventions

14. monitoring healthy lifestyle

15. pharmacological treatment and skin treatment

16. rehabilitation activities (walking, exercises, etc.)

17. positioning and supporting mobility

18. educational interventions for your relatives and friends

% older adults reporting activities

1.1

Lis

t o

f ac

tivi

tie

sSocial guardian

0 10 20 30 40 50 60 70 80 90 100





5. companionship


7. Home Environment assessment in terms of safety, hygiene,…

8. Assistance in the prescription and use of principals tools you…




12. Support to daily activities (shopping, going to a medical…







% older adults reporting activities

1.1

Lis

t o

f ac

tivi

tie

s

Homecare assistant/home helper

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Figure 19 Rehabilitation staff services reported by older adults

0 10 20 30 40 50 60 70 80 90 100





5. companionship


7. Home Environment assessment in terms of safety,…

8. Assistance in the prescription and use of principals…




12. Support to daily activities (shopping, going to a…







1.1

Lis

t o

f ac

tivi

tie

sRehabilitation staff

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Answering to the question “What is the average time ACTUALLY spent by professional at your home each time

he/she comes?” the older interviewed report different profile of time per performance based on the

professional delivering the service. In particular (Figure 20 What is the average time ACTUALLY spent by

professional at your home each time he/she comes?) the data show that the professionals the spend most

time at home of the older adults, based on Modal Value, is the Homecare assistant/Home helper (from 4 to

8h), followed by rehabilitation staff and Social guardian (from 1 to 2 h). Comparing these data with the ones

coming from the questionnaires administered to the HHCP, there is a substantial correspondence and

matching between the older adults and HHCP point of view.

Figure 20 What is the average time ACTUALLY spent by professional at your home each time he/she comes?

Analyzing the answers of older adults regarding the weekly frequencies of the services of HHCP Figure 21 How

many times on average do you receive the visit of the professional at your home in a week?, the frequency of

the service profile is variable for the different HHCP. In particular the modal value of the social guardian is

from 2 to 3 times per week, the one of Homecare assistant form 5 to 7 times per week and Rehabilitation staff

once or less than once per week. This data are partially coherent with the data coming from the questionnaire

administered to HHCP. On the same questions the Social guardians interviewed reported that their

performance frequency is from 2 to 3 times per week. The older adults reported that number of performances

per week performed by Homecare assistant/Homecare helper are from 5 to 7 (mode value), in coherence with

the description arising from the results of the HHCP questionnaire.

0,00

10,00

20,00

30,00

40,00

50,00

60,00

70,00

80,00

90,00

100,00

> 15 minFrom 15 to 30 minFrom 1 to 2 hfrom 2 to 4 hfrom 4 to 8 h 24h/24h

Social Guardian

Homecareassistant/homehelper

Educator

Rehabilitationstaff

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Figure 21 How many times on average do you receive the visit of the professional at your home in a week?

Answering to the question How can you define the relation/interaction that you normally establish with the

professional that visit you at home? the older adults interviewed reported that the relationship perceived

friendly (50,0% professional 46,4% deep 17.9% and distant 10.7%.Distinguishing between the different HHCP,

the older adults perceive as friendly the social guardians, professional and friendly the rehabilitation staff and

professional the Homecare assistant/home helper.

Figure 22 How can you define the relation/interaction that you normally establish with the professional that visit you at home?

0,00

20,00

40,00

60,00

80,00

100,00

120,00

1.Less thanonce

2. Once 3. From 2 to3 times

4. From 3 to5 times

5. From 5 to7 times

6. Morethan 7 times

Social guardian

Homecareasstistant/homehelper

Educator


0,00

10,00

20,00

30,00

40,00

50,00

60,00

70,00

80,00

90,00

100,00

1. deep 2. friendly 3.professional 4. distant 5. other

Social guardian

Homecareassistant/home helperEducator


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8.5 HHCP involved in older persons homecare service in Italy: roles and competences

8.5.1 Nurses

In Italy there’s no specialization for nurses involved in homecare. After a three-year academic degree (EQF6), compliant with the “European agreement on the

instruction and education of nurses”, Strasbourg, 25 October 1967 [Foreign and Commonwealth Office], nurses can provide public and private home nursing to

older adults.

The Bachelor’s Degree in Nursing, which belongs to the Nursing and Midwifery Class of degrees (Class SNT/1), is a three-year course divided into 6 terms (2 per

academic year). Pursuant to Law no. 264 dated 2.8.1999 admission to any Nursing degree course involves a selective entry test. The course requires students to

get 180 credits and aims at training health care professionals, equipping them with the scientific and technical knowledge and skills to work independently and

provide assistance as nurses. Nursing assistance has a technical, relational and educational component and is provided to paediatric, adult and geriatric patients.

Therapeutic, palliative and rehabilitation sides of the nursing practice are covered as well.

The coursework meets the criteria and complies with the rules and regulations laid out by the European Union for the nursing profession. One of the most

significant aspects of the training is the practical and clinical training, as laid out by the EU rules. The clinical training is carried out under the supervision of

professional tutors and coordinated by fully-trained and highly respected clinicians. Students who hold a Bachelor’s Degree in Nursing can go on to study for

Master’s Degree in Nursing and Midwifery.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE

know what - theoretical and/or

factual knowledge

SKILLS

know how to do - SKILLS as cognitive

COMPETENCIES

know how to be

HEALTH PREVENTION & EDUCATION Knowledge about: Hygiene-preventive sciences to understand health determinants, risk factors, individual and community prevention strategies, and interventions to promote the safety of health workers and patients.

Skills to: Promote health with preventive and healthcare interventions for patients, families, and the community; Initiate and support residual abilities of people to promote adjustment to limitations or alterations caused by disease and to modify lifestyles; - plan and implement, in collaboration

Competencies to: Use and apply theoretical models and role models within the healthcare process to improve, develop, recover, and promote the public’s health; Plan health educational campaigns in various social contexts and for different age groups.

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


factual knowledge

SKILLS


COMPETENCIES

know how to be

with other professionals information and educational activities to control risk factors for individuals or groups; - educate people to better health lifestyles and change hose at risk.

NURSING Knowledge about: - Biological phenomena, principal functioning mechanisms of organs and systems, hereditary and physiological phenomena, also in relation to the psychological, social, and environmental dimensions of health and illness.;

- fundamentals of physiology and pathology applicable to various environmental and clinical situations of a person;

- the nursing care needs of individuals and the community and formulate the respective objectives;

- the basic cultural and professional principals that guide the process, conceptuality, diagnostic reflection, nursing actions in relation to

Skills to: - use the process of nursing care when taking charge of patients; - define intervention priorities based on healthcare needs, organizational needs and on the optimal use of available resources; - document nursing care that has been provided; - identify the needs for nursing care, differentiated from the work done by support workers and other professionals; - handle computerized information systems and those using leaflets to support nursing care; - delegate and supervise caring

Competencies to: - make nursing care decisions; - set nursing care intervention priorities; - decide which interventions to delegate to support workers; - conduct nursing care by customizing choices based on similitudes and differences among patients in relation to values, ethnic groups and social-cultural traditions; - critically assess the outcomes of nursing care decisions made in relation to patients’ responses and healthcare standards; - manage conflicts arising from diverging positions;

Deliverable 2.1


ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


factual knowledge

SKILLS


COMPETENCIES

know how to be

individuals and the community;

- the general and clinical nursing sciences to understand the areas of nursing intervention, the clinical method that guides an effective approach to care, practical intervention techniques and scientific evidence that guide decision making.

activities to support workers; - work within a team respecting everyone’s scope of practice; - check patients’ problems with structured and systemic techniques by detecting alterations in the functional models.

- collaborate with the healthcare team to agree the operational plans, and implement and develop protocols and guidelines.

NURSING Knowledge about: Ethical, legal and sociological sciences to understand the organizational complexity of the Health System, the importance and usefulness of abiding to rules and regulations, as well as the respect for values and ethical dilemmas that occur during daily practice; Professional autonomy, areas of integration and interdependency with other members of the healthcare team; Basic and applied biomedical sciences

Skills to: Document nursing care provided according to legal and ethical principals; Ensuring that patients and their families and/or significant others get the information and support for healthcare continuum and the recovery of one’s health resources. Ensure and effective physical and psychosocial environment for the safety of patients; Adopt actions that protect from

Competencies to: Plan and implement appropriate nursing interventions that consider people’s values and beliefs; Being responsible for actions linked to their roles and being accountable for actions related to their profile (DM 739/94), the code of conduct, and ethical and legal standards. Establish and maintain helpful relationships with their patients and their families, by applying the fundamentals of relational dynamics.

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


factual knowledge

SKILLS


COMPETENCIES

know how to be

to understand the physiological and pathological processes linked to the health and illness of people across their life span. Public health-preventive sciences to understand health determinants, risk factors, prevention strategies, both individual and collective, and interventions aimed at promoting the safety of health workers and patients.

physical, chemical, and biological risks in the workplace; Take precautions when manually moving weights; Adopt strategies for the prevention of infectious risks (standard precautions) both in hospitals and in the community; Use validated clinical healthcare instruments to manage clinical risk (e.g. pre-op check-lists, fall charts) Adopt risk management tools to manage adverse events

Identify and manage risk factors. Ensure safety and risk control during patient care.

THERAPEUTIC EDUCATION Knowledge about: Psycho-social and humanistic sciences to understand the normal and pathological relational dynamics, and people’s defence reactions and adjustment to situations of psychic, social distress, and physical suffering; Learning and change theories to understand educational processes for

Skills to: Design with patients and their families educational projects to develop self-care skills; Adopt communication models that facilitate the understanding of the educational project; Set up informal healthcare networks

Competencies to: Use appropriate communications skills (verbal, non-verbal, and written) with patients of all ages and with their families within the healthcare process and/or with other health professionals in the appropriate verbal, non-verbal and written form; Use teaching and learning principals

Deliverable 2.1


ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


factual knowledge

SKILLS


COMPETENCIES

know how to be

the public and patients; Group dynamics and managing groups

to support patients and their families during long term healthcare projects; Plan patient discharge.

for specific information and educational interventions for individuals, families, groups, and other professionals (support workers, nurse students, nurses); Support and encourage people to make healthcare choices, reinforcing coping skills, self-esteem and enhancing available resources.

RESEARCH Knowledge about: Computer and languages disciplines, particularly English in order to understand nursing scientific literature and use databases; The methodological approach to quantitative and qualitative research, Evidence Based Nursing and Best Practice

Skills to: Search the literature according to the issues that emerge from clinical practice; Critique the literature; Conduct evidence based practice based on patients’ values, beliefs and preferences, available resources and clinical judgement.

Competencies to: Apply nursing research results to improve the quality of care; Use instruments and methodologies to evaluate and review the quality of care; Provide safe, effective, and evidence based nursing care.

MANAGEMENT Knowledge about: - General and clinical nursing sciences, and national and international

Skills to: Apply, manage and document diagnostic and therapeutic pathways;

Competencies to: Use appropriate communication methods within the multiprofessional

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


factual knowledge

SKILLS


COMPETENCIES

know how to be

regulations to manage and organize care in order to facilitate the fields of nursing intervention and improve patient and family outcomes. - The clinical method as an effective approach to care, and operational intervention techniques that guide decision-making; - Psycho-social and humanistic sciences to understand the relational dynamics within a working group.

- Ensure correct application of therapeutic protocols and monitor their efficacy; - Start decision making processes based on the patient’s conditions, altered vital signs, medical reports and lab tests; - Manage diagnostic pathways ensuring an adequate preparation of the patient and surveillance after the procedure; - Integrate nursing care in the multidisciplinary care plan; - Use instruments for professional integration (meetings, team meetings, case discussions); - Start interventions required to manage acute and/or critical situations; - Identify and prevent factors that cause acute episodes in chronic

team; - Manage conflicts caused by diverging positions; - Facilitate the coordination of care to achieve the agreed healthcare outcomes; - Be accountable of one’s work during practice in line with the professional profile, the code of conduct and ethical and legal standards; - Make decisions using a scientific approach to solve patients’ problems; - Analyse organizational problems and suggest solutions; - Make decisions when there are diverging positions (conflicts or dilemmas).

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


factual knowledge

SKILLS


COMPETENCIES

know how to be

patients.

EDUCATION Knowledge about: The educational approaches described in the andragogical model; - Regulations about gaining continued medical education credits.

Skills to: Check one’s own learning needs; - Design learning plans to run educational activities that support professionalization; - Take leading roles over support workers and/or students; - Develop one’s own profile; - Collaborate in the design, provision, and assessment of educational programmes.

Competencies to:

To supervise students during their clinical learning placements, educate and facilitate the introduction of newly employed nursing staff, train support workers, and refresh one’s own level of education and competencies;

8.5.2 Physiotherapists

The physiotherapist is an health care professions of rehabilitation (L/SNT2) which requires a 3 years degree (180 credits) Physiotherapy graduates are healthcare professionals who carry out, independently or working with other professionals, prevention, treatment and rehabilitation work for motor skills, higher brain function and visceral function, after a pathological event has occurred.

Deliverable 2.1


Physiotherapy graduates draw up, on their own or with a team, on the basis of a doctor’s diagnosis and prescription, a rehabilitation plan aimed at identifying and meeting the health needs of a disabled person; independently carry out treatment for the functional rehabilitation of motor, psychomotor and cognitive functions (physical therapy, manipulation, massage and occupational therapy); recommend the use of prosthetics , orthotics and other devices and help patients get familiar with them and make sure they are effective; they make sure that their rehabilitation techniques meet the goals of functional recovery; they offer consulting and training for health care services and wherever they are needed.

ROLE3 (SET OF ACTIVITIES)

KNOWLEDGE know what - theoretical and/or

factual knowledge

SKILLS know how to do - SKILLS as cognitive

COMPETENCIES know how to be

PREVENTION

Knowledge of health needs and the modalities for preventing disabilities

Know how to promote health needs

and the modalities for preventing

disabilities

Evaluate how and when to promote

health needs and the modalities for

preventing disabilities

To promote actions for health

promotion and for overcoming

disabilities

Know how to act for health promotion

and for overcoming disabilities

Evaluate how and when implement

actions for health promotion and for

overcoming disabilities

Knowledge of methods for preventing

increased of disabilities

Know how to implement actions for

preventing increased of disabilities

Evaluate how and when implement

actions for preventing increased of

disabilities

CARE AND REHABILITATION Knowledge of individual and

community needs related to physical,

philological and social

fields/environments subjected to

functional recovery

Know how to identify individual and

community needs related to physical,

philological and social

fields/environments subjected to

functional recovery

Evaluate how and when act on

individual and community needs

related to physical, philological and

social fields/environments subjected

to functional recovery

3 Source: AIFI – Italian Physiotherapists Association - Physiotherapist Core Competencies http://aifi.net/wp-content/uploads/2013/01/corecompetencecorecurriculum.pdf

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factual knowledge



Knowledge of the acquisition and

explanation modalities regarding data

from physiological and pathological

anamnesis, body parts and its

physiology as well as activities related

to individual and environmental

factors

Know how to collect and read data

from physiological and pathological

anamnesis, body parts and its

physiology as well as activities related

to individual and environmental

factors

Knowledge of different processes

related to patients’ evaluation

consisting of reliable clinical and

instrumental tests and clinical

examination

Know how to carry out patients’

evaluation by means of reliable clinical

and instrumental tests and clinical

examination

Knowledge of analysis and evaluation

processes in order to: (i) determine

functional abilities and potential

outcomes related to clients and

caregivers choices and (ii) to express a

functional diagnosis and based on that

the prognosis

Know how to evaluate and analyse

clinical and instrumental data in order

to (i) determine functional abilities

and potential outcomes related to

clients and caregivers choices and (ii)

to express a functional diagnosis and

based on that the prognosis

Evaluate a clinical reasoning based on

clinical and instrumental information

in order to(i) determine functional

abilities and potential outcomes

related to clients and caregivers

choices and (ii) to express a functional

diagnosis and based on that the

prognosis

Knowledge of the processes for

determine the therapeutic goals,

intervention priorities, the ongoing

Be able to define and determine the

therapeutic goals, intervention

priorities, the ongoing evaluations

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factual knowledge



evaluations based also on

client/caregivers choices.

based also on client/caregivers

choices.

Knowledge of different evaluation

modalities (also as working as a team),

and of the rehabilitative intervention

efficacy.

Be able to carry out clinical and

instrumental evaluation (also in a

context of team working), and be

aware of the rehabilitative

intervention efficacy.

THERAPEUTIC EDUCATION

Knowledge of the basis for building

educational programs for clients and

care-givers and verifying its

pertinence.

Know how to identify the basis for

building educational programs for

clients and care-givers and verifying its

pertinence.

now how to built an educational

programs for clients and care-givers

and verifying its pertinence

Knowledge of teaching and

educational activities for supporting

individual and community well-being

by means specific interventions

now how to carry out teaching and

educational activities for supporting

individual and community well-being

by means specific interventions

TRAINING AND SELF-LEARNING

Knowledge of processes for adapting

teaching courses based on learning

and training needs and competences

and verifying their pertinence.

Know how to plan teaching courses

based on learning and training needs

and competences and verifying their

pertinence.

Knowledge of how to better

implement your practice in order to

learn from experience (during training)

Knowledge of how to better

implement your practice in order to

learn from experience (during training)

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factual knowledge



dealing with standard and specific

situations requesting comparison and

feedback about your intervention to

training tutors and self assessing the

implementation of knowledges and

skills

dealing with standard and specific

situations requesting comparison and

feedback about your intervention to

training tutors and self assessing the

implementation of knowledges and

skills

EBP – EVIDENCE BASED PRACTICE Knowledge of how to put a question

starting from a specific clinical issue,

putting it in order to come to a simple

answer and how to design the most

appropriate way to answer.

Know how to find available clinical

evidences by consulting proper

general and specific databases and

main search engines; Know how

approach critically the scientific

production

Be able to assess the opportunity to

modify your clinical practice on the

base of collected evidences

acknowledging the patient's needs

and your experience (about EBP and

EBH)

Knowledge of scientific literature

sources, of different kind of studies

and their hierarchy

Know how to identify, basing on a

question, the most appropriate

research project to properly answer.

Be able to consult clinical research in

order to modify your clinical practice

Know how to find, read and analyse

critically the current scientific

literature by consulting proper

databases both general and specific

and main engine searches.

Be able to modify your clinical practice

acknowledging patient's values\needs

and your experience.

PROFESSIONAL RESPONSIBILITY

Knowledge of the evolution of the

profession and discipline, knowledge

of the concepts of autonomy and

Know how to take charge of the

person in respect of professional

ethics and deontology; know how to

Be able to practice in observance of

professional profile, deontology and

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factual knowledge



accountability regarding the PT;

Knowledge of the relation between

the PT and other professionals; in

depth analysis about ethics,

deontology and legal alt both national

and European level.

protect the profession; law regarding the profession.

Ensure an appropriate intervention

respecting professional boundaries

and your level of experience.

Keep a polite relation between PT and

other involved subjects.

Knowledge of cultural and society

related different needs

Know How to receive patients and

relatives in different context; Know

how to show respect and sensitivity

for the patient, for his right, for his

dignity and personal aspects, including

age, sex, lifestyle, ethnic group,

language, health condition,

behavioural and cognitive

Be able to behave in respect of

different ethnic implications regarding

his corporeity different ways of

communicate with the patient

considering feelings, thoughts, cultural

and religious principles

knowledge of patient's and caregiver's

cantered approach

Know How to involve patients and

caregivers in making decisions process

Be able to involve and inform patients

and relatives about the chosen

intervention (Prevention, care and

rehabilitation) in order they can accept

or refuse the therapeutic proposal.

Knowledge of the legal aspects

concerning the profession about

accountability, information, listening

To know how to act in respect of

patient's privacy and confidentiality

Be able to collect agreement where

needed, know how to behave in

Deliverable 2.1




factual knowledge



and agreement in healthcare area;

about privacy, personal and sensitive

data, patient's confidentiality

observance of patient's confidentiality

Knowledge of the accountability of

your own decisions and actions

Know How to support your own

professional choices

Be able to ensure efficient and

effective performance for the best

patient's interest implementing

criteria of transparency of the price list

MANAGEMENT

Knowledge of the main theories about

interpretation and knowledge of

making decisions process

Know how to utilize the phases of the

process in the clinical area; Know how

to find adaptive solutions to

overcoming problems

Be able to implement problem-solving

in making decisions

Knowledge of your working institution Know how to manage your duty into

your institution

Be able to operate acknowledging

roles and competencies of other equip

members, know how to unify

operative modalities; know how to

underline problems and to propose

solutions; know how to monitor

outcomes

Knowledge of clinical risk and

operating by quality standards

Know how to identify adverse events;

know how to manage clinical risk

Be able to operate safely by

him/herself and others, know how to

implement strategies to minimize risk

possibility

Deliverable 2.1




factual knowledge



Knowledge of delivering quality

standards

Know how to deliver quality standards

by using operational and

computerized tools to collect and

analyse data; Know how to analyse

critically the process in order to solve

issues.

Be able to manage the work by

managing spaces, time, assets and

working plans using data collection to

apply corrections if needed.

COMUNICATION AND RELATIONS Knowledge of establishing and

supporting an effective way of

communication with the patient and

other related professional

Know how to write effectively to

patients, caregiver and others related

professionals

Evaluate how and when to establish

and manage an helping relationship

with patients and care-givers

Knowledge of communicating

effectively with other healthcare

professionals or other significant

professionals to ensure an effective

and efficient service to the user

Know how to cooperate with other

members of the team about the

planning, supervision and assessment

of the patient’s outcomes

Evaluate how to manage the relational

issues between the team\working

group

Knowledge of managing objectives

and solve clashes

Know how to manage objectives and

solve potential clashes

Be able to implement strategies to

prevent\solve clashes

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8.5.3 Psychologist

Despite the indication of the Ministry of health, in Italy are very few the psychologist working in public services

in homecare sector for older adults. Clinical psychological intervention are most performed in private sectior

and in studio setting. There are no specific training course and competences definition for older adults

homecare. There are several post degree courses on psychogeronthology and aging psychology, but these are

not mandatory to perform work as psychologist in homecare for older adults.

The profession of psychologist, as described by the Law of. 18 Febrary 1989, n. 56., includes the use of

knowledge and tools for the intervention to prevent, diagnose and rehabilitate and support in psychological

field for people, groups, social institutions and communities. Includes the activities related to experiment,

research and education in this field.

As described in the art.2 of Law of. 18 February 1989, n. 56.,the requirements to practice the psychologist

profession is necessary

• to have obtained the master degree in psychologist,

• to be in possession of proper documentation proving the execution of a training period accordance

with rules laid by the Minister of Education

• to have obtained the qualification thought the state certification exam

• to be a member of the professional board.

There are no detailed documents describing role, activities, competences for the psychologist working in the

homecare for older adults. In the list of the more frequent activities performed by professionals in the home

care ( Nuova caratterizzazione dell’assistenza dell’assistenza territoriale domiciliare e degli interventi

ospedalieri a domicilio, 2006), the ones related to psychological roles/activities includes:

1. Supportive care for patients and families

2. Individual consultation to operators of the team

3. Supervision of team activities

4. Support talks and elaboration of mourning

Despite these list provided by Ministry of Health regarding the most frequent activities performed by

psychologists, there are other activities not included in the list, that could be requested by a psychologist in

the homecare for older adults setting.

The main occupation of psychologist in the clinical field are defined by “La Professione Di Psicologo:

Declaratoria, Elementi Caratterizzanti Ed Atti Tipici” (National Order of Psychologists, 2015) and the

competences can be extracted from the definitions of the Master degree in Psychology (LM – 51) and the

definition of the knowledge, skills and competences defined by “Determinazione delle classi di laurea

magistrale” (Decreto Ministeriale 16 marzo 2007 Pubblicato nella Gazzetta Ufficiale del 9 luglio 2007 n. 155)

and “Riassetto delle Scuole di Specializzazione di area Psicologica” (Decreto Ministeriale 24 luglio 2006

Pubblicato nella Gazzetta Ufficiale del 21 ottobre 2006 n. 246).

Deliverable 2.1


ROLE

(SET OF ACTIVITIES)

KNOWLEDGE

know what - theoretical and/or factual

knowledge

SKILLS


COMPETENCIES

know how to be

PREVENTION

He knows the main explanatory theories in the field of general and physiological psychology, social psychology and community, dynamic and clinical psychology; psychopharmacology; psychogeriatrics; psychiatry; neurology

work with appropriate methodologies for the promotion of health and well-being

capacity of independent and critical judgment in evaluating individual situations, family, community and organizational.

is able to develop evaluation capacity about problems and situations through the use of knowledge and information acquired formulating judgment of priorities and the reasons for it, anticipating outcomes of their choices with possible consequences / effects and developing strategies to redefine the objectives / behaviors on the basis of the monitoring results

has knowledge in related disciplines and complementary to the psychological sciences, specifically in the field of neuroscience and the

philosophical disciplines, anthropological,

use the knowledge and methods acquired to work in

multidisciplinary teams, offering in this area a specific


Deliverable 2.1


ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


COMPETENCIES

know how to be

sociological and pedagogical psychological support; be able to learn from the experience and collaboration with colleagues and also professionals from other disciplines.

be able to interact with different professional psychologist;

DIAGNOSIS

He knows the main explanatory theories in the field of general and physiological psychology,

social psychology and community, dynamic and clinical psychology; psychopharmacology;

psychogeriatrics; psychiatry; neurology

- applying diagnostic tools;


be able to develop evaluation capacity about problems and situations through the use of knowledge and information acquired formulating judgment of priorities and the reasons for it, anticipating outcomes of their choices with possible consequences / effects and developing strategies to redefine the objectives / behaviors on the basis of the monitoring results;

Deliverable 2.1


ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


COMPETENCIES

know how to be


philosophical disciplines, anthropological, sociological and pedagogical



psychological support;


be able to learn from the experience and collaboration with colleagues and also professionals from other disciplines.

be able to interact with different professional psychologist;

ABILITATION/REHABILITATION




Apply with responsibility the mastered knowledge about design, development and

evaluation of interventions targeting individuals, groups and communities in different

contexts


is able to develop evaluation capacity about problems and situations through the use of knowledge and information acquired formulating judgment of priorities and the reasons for it, anticipating outcomes of their choices with possible consequences / effects and developing strategies to redefine the objectives /

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


COMPETENCIES

know how to be

behaviors on the basis of the monitoring results;

He knows the methods of design and evaluation of interventions in individual field, group, community and organizational;

They will also be able to manage the complexity arising from the analysis this situation and making decisions about the choice of interventions aimed at individuals, groups or communities.






able to communicate effectively with colleagues of other disciplines, offering precisely specific contribution;

be able to learn from the experience and collaboration with colleagues and also professionals from other disciplines. be able to interact with different professional psychologist;


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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


COMPETENCIES

know how to be

SUPPORT




applied maturely and responsibly the knowledge

gained in the design, implementation and evaluation

of interventions aimed at individuals, groups,

communities, in different organizational contexts;

Be able to develop evaluation capacity about problems and situations through the use of knowledge and information acquired formulating judgment of priorities and the reasons for it, anticipating outcomes of their choices with possible consequences / effects and developing strategies to redefine the objectives / behaviors on the basis of the monitoring results;

be able to manage the complexity arising from the analysis this situation and making decisions about the choice of interventions aimed at individuals, groups or communities.

He knows the methods of design and evaluation of interventions in individual field, group, community and organizational;

Be able to communicate effectively with colleagues of other disciplines, offering precisely specific contribution;


philosophical disciplines, anthropological,



be able to learn from the experience and collaboration with colleagues and also professionals from other

Deliverable 2.1


ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


COMPETENCIES

know how to be

sociological and pedagogical psychological support; disciplines.

Be able to interact with different professional psychologist;

be able to manage the complexity arising from the analysis this situation and making decisions about the choice of interventions aimed at individuals, groups or communities.

PSYCHOTHERAPY

He knows the main explanatory theories in the field of general and physiological psychology, social psychology and community, dynamic and clinical psychology; psychopharmacology; psychogeriatrics; psychiatry; neurology

applied maturely and responsibly the knowledge

gained in the design, implementation and evaluation

of interventions aimed at individuals, groups,

communities,

be able to develop evaluation capacity about problems and situations through the use of knowledge and information acquired formulating judgment of priorities and the reasons for it, anticipating outcomes of their choices with possible consequences / effects and developing strategies to redefine the objectives / behaviors on the basis of the monitoring results;

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


COMPETENCIES

know how to be

General theoretical knowledge of the fundamental pathogenetic mechanisms of central nervous system diseases, peripheral and vegetative, psychiatric disorders, personality disorders and specific forms of psychological distress of the different phases of the life cycle;

be able to develop evaluation capacity about problems and situations through the use of knowledge and information

acquired formulating judgment of priorities and the reasons for

it, anticipating outcomes of their choices with possible consequences / effects and

developing strategies to redefine the objectives /

behaviors on the basis of the monitoring results;

able to communicate effectively with colleagues of other

disciplines, offering precisely specific contribution;

general theoretical knowledge and basic experience related to neurological diseases, psychiatric, neuro- and psychomotor, also with reference to behavioral and psychological complications of internal medical and metabolic diseases and organ diseases throughout the life cycle and with particular reference to their psychological impact on family and social contexts

the methods of design and evaluation of interventions in individual field, group, community and organizational;






be able to learn from the experience and collaboration with colleagues and also professionals from other disciplines.

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


COMPETENCIES

know how to be

It is able to interact with different professional psychologist;

be able to communicate effectively with stakeholders within organizations;

MANAGEMENT

Knowing the territorial social health organization (ex ASL, MMg ..), regional,

national and european

Knowing how to define its own role, to his affiliation or professional free scheme to delineate the frames and potential of the work

be able to communicate effectively with stakeholders

within organizations; It is able to interact with

different professional psychologist;

Knowing how to Report the own work, handle tools properly and securely.

the voluntary sector and voluntary work

8.5.4 Professional Educator

A graduate of the Professional Education (Health Care Profession) degree. Professional Educators are health care professionals specialised in rehabilitation. Their work activities contribute to specific projects in the fields of education and rehabilitation to promote a balanced development, rehabilitation and social reintegration of physically or psychologically disadvantaged individuals, or people who are at risk of being socially marginalised.

Deliverable 2.1


ROLE (SET OF ACTIVITIES)


factual knowledge

SKILLS

know how to do - SKILLS as

cognitive and practical

COMPETENCIES know how to be -

RELATIONSHIP

Know how to relate to the individual, their family, the

community

Start a relationship

Use an ‘educational relationship’in order to establish rapport with the individual

and their family, ascertain the person’s needs,

share the proposed plan with them, keep on sustaining the

relationships that make it possible for the necessary support to the educational process to be found within the family

and the community.

Maintain,

strengthen,

and repair

existing relationships

Create new relationships

Be familiar with social participation and active citizenship processes

Encourage social life by making the most of the community’s resources

Encourage participation in activities and events organised by external agencies

and services

ELEMENTS OF GERIATRICS

Learn about the process of ageing (physical, cognitive, psychological

and social issues)

Slow down physical decline

(encouraging physical exercise in

cooperating with physiokinetic

therapy)

Together with the working team to identify actions to be taken in order to promote active ageing, i.e. adopting a new lifestyle that can slow down or

counter the loss of functions/abilities

Promote strategies to maintain the main cognitive functions (focus, memory,

language)

Slow down cognitive decline

(formal and informal ROT,

promoting space and time

orientation and adapting your

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factual knowledge

SKILLS




environment)

Promote psychological welfare

Preventing social decline

(encouraging people to engage

‘actively’ in the community – free

time activities and volunteering )

HANDLING AUTONOMY

Be familiar with ADL And IADL

(instrumental activities of daily living)

Assess the ability to make a meal, maintain personal hygiene, get

dressed, deal with domestic chores, take meds, be out and about, take public transport, use a phone, …

Systematic observation

Put into place strategies to challenge and

help the person to carry out daily life tasks in order to promote autonomy and

independency

HOME ECONOMICS Be familiar with the basics of

looking after the home

Monitor the environment Identify risks in the home

Promote a prosthetic environment

Adapt the environment, especially for dementia/cognitive deficit cases

Report a risk of poor hygiene

Assess a risk of poor hygiene in the home

Take actions to reduce risks

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factual knowledge

SKILLS




Be familiar with the basic of healthy eating

Help the elderly person eat healthily Help the elderly person to do/manage

their shopping

THERAPEUTIC ALLIANCE

Prevent risk for mental and physical health

Report a health risk (to whom, how, timeframe)

To the family, the team members, the local services

Assess domestic risk to physical and

mental health, using the rapport with the person and the

family which is based on trust and cooperation

Take actions to reduce risk with individual educational activities

Monitor the person’s health

Check the person health condition from time to time by enabling his access to the MMG and other medical units in his area

Work with the GP and familiarity with local services

Be familiar with the basics of keeping safe while moving (assess

the risk of falls)

Implement strategies to have the elderly person appropriately

escorted when he/she leaves the house

Identify tools that can be of help when the person is out and about (cane,

walking frame, etc.) with the help of the doctor/physical therapist

Therapy intake

Help the person when it comes to handling the medicines he/she has to take and check that he/she takes

them correctly.

Action that requires working closely with a GP and a RN

Team work

Be familiar with the network of services (health and social

professional, social and health organisations – administrative

offices, clinics, day centres, residential facilities…)

Point the elderly or their relatives to the main existing services that can

improve their quality of life and help the family.

Be familiar with and able to assess the

procedure to get a service to take on the elderly person

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factual knowledge

SKILLS




Promote active citizenship

Get formal and informal support going to promote an active lifestyle

Get a support network going (friends, volunteers, acquaintances)

Regularly meet as a team to write down the IAP and assessment

Design long and medium term educational actions

Work with social and health professionals in a shared design perspective

8.5.5 Occupational Therapist

Occupational therapists are identified by Italian law as one of the health professions for rehabilitation. After a three-year academic degree (EQF6), they can

provide public and private homecare to older adults.

During the primary prevention stage, the Occupational Therapist fosters a healthy lifestyle at different levels: for the individual, the group, the organization and

the community. During the secondary prevention stage the Occupational Therapist focuses on the individuals, with or without disabilities, who found themselves

at risk of performance problems in order to prevent negative factors to arise or increase, as they may affect the performance. During the third prevention stage

the Therapist fosters occupational performance at all ages and in any kind of physical and mental dysfunction, be it either temporary or permanent.


KNOWLEDGE know what - theoretical and/or factual

knowledge

SKILLS

know how to do - SKILLS as cognitive and practical


4 Source: AITO – Italian Occupational Therapists Association - Occupational Therapist Core Competencies

http://www.aito.it/sites/default/files/Competenze%20Generali,%20Specifiche%20e%20Professionali.pdf

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knowledge

SKILLS



OCCUPATIONAL THERAPY PROCESS AND A PROFESSIONAL WAY OF THINKING

Basic notions of biologic, medical, human, psychological, social, technologic sciences in professional way of thinking

Implement relevant knowledge from biological, medical, human, psychological, social and technologic sciences in a professional way of thinking

Be familiar with the critical issues of

implementing formal theories and

scientific evidence to the field of

employment, in the context of an ever-

changing society

Identify patient employment profile

Be familiar with employment nature of human beings and their employment performance

Make use of the therapeutic value of

employment Analyse the types of employment

Adapt and implement occupational therapy processes in close collaboration with users

Be familiar with the relationship between occupational performance, health and wellness

Explain the relationship between occupational performance, health and wellness

Lay down a therapeutic relationship as the basis for the therapeutic occupational process

Set up collaborative relationships, get opinions from clients, family, members of the team and management in order to make employment and active participation easier

PROFESSIONAL

INDEPENDENCE AND

RESPONSIBILITY

Be familiar with the main documents of the occupational therapy process

Prepare, manage and update documents about the occupational therapy process

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knowledge

SKILLS



Be familiar with local, regional, national and European protocols and procedures;

professional standards and employer rules

Carry out client-centred work Practice the profession ethically, respecting clients and professional standards and ethics

Be familiar with the role of occupational therapist in relation with the other professionals who work alongside occupational therapists

Know how to work in a team

Be familiar with the main concepts of information technology and Internet

Know how to surf the net, carry out researches, use email systems and main information technology systems

Be familiar with the main clinical evidence sources

Know how to carry out an internet search and using the main clinical evidence databases

Understand, analyze, summarize and review critically the results

MANAGEMENT OF

SOCIO-WELFARE-

REHABILITATION NEEDS

OF THE PEOPLE IN THE

PRIMARY PREVENTION

STAGE BOTH SANITARY

AND SOCIAL

Be familiar with occupational theories in relation with lifestyle and occupational

roles

Assess individual/ group/organization/community lifestyle and occupational role in order to identify possible factors limiting occupational success

Evaluate the socio-sanitary context in order to identify the pros and cons in terms of individual/ group/organization/community occupational wellness

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knowledge

SKILLS



Be familiar with the theories and professional practice models in order to satisfy individual / group/ organization / community needs

Implement theories and professional practice models in order to satisfy individual / group/ organization/ community needs

Be familiar with theories and rules in order to evaluate the accessibility and safety of the places we live in (external spaces included), as well as routes

Evaluate accessibility and safety of the places we live in (external spaces included) as well as routes

Be familiar with the main characteristics of daily life places (home, school, community/territory) should have

Evaluate daily life places in order to check if they satisfy individual/group/community occupational needs

Be familiar with the main theories and rules of the design of workstations and the furnishing of accessible and ergonomic settings

Design workstations and furnish rooms in order to ensure accessibility and ergonomics

Be able to provide consultations on workstation design and accessible

and ergonomic furniture

MANAGEMENT OF

SOCIO-WELFARE NEEDS

OF PEOPLE IN THE

SECONDARY

PREVENTION STAGE

BOTH SANITARY AND

Be familiar with the standard instruments for preliminary identification of negative factors for occupational performance

Use standard instruments for preliminary identification of negative factors for occupational performance

Be familiar with the main risk factors Reduce risk factors through occupational involvement

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knowledge

SKILLS



SOCIAL Be familiar with occupational perspectives in order to prevent disease and disabilities and to foster health

Provide consulting to and collaborate with organizations and communities on how those occupational perspectives are able to prevent disease and disabilities and promote health

Operate in order to keep independence in everyday activities, in social interactions and mobility within the community of the individual/the group/ the organizations/ the communities which are at risk of compromised occupational performance

Foster the setting up of a “social network” in order to ease the integration of the individual in his/her daily life, in collaboration with local resources

Management of socio-

welfare needs of people

in the THIRD

PREVENTION stage both

sanitary and social

Be familiar with the main preparatory

devices for occupational performance

recovery

Be familiar with the main preparatory

devices for occupational performance

recovery

Evaluate and foster the use of the main preparatory devices for occupational performance recovery

Be familiar with theories and procedures

in order to draw up an employment

profile of the patient in acute phase or

post-acute phase

Draw up an employment profile of the

patient in acute phase or post-acute phase

Evaluate performance skills in personal care

Evaluate body structures and functions in relation with occupational performance

Evaluate lifestyle before the acute phase occurrence

Deliverable 2.1




knowledge

SKILLS



Be familiar with the main characteristics of the projects about: recovery (development and restore); change (compensation and adaptation); prevention; promotion or keeping in order to reinsert the user in the job setting

Analyse, adapt and phase in employment through the analysis of occupation. Plan an employment action in order to foster health and wellness

Evaluate limits in activity

Ensure continuity in welfare-rehabilitation activities in the user’s life and set the focus on the integration of local structural and professional resources

Collaborate with a multi professional team in order to focus the therapy on the early promotion of independence

8.5.6 Social Health Operator (OSS)

This new figure, known as OSS – Social-Health Operator (operatore socio-sanitario), was introduced by The State-Regions Conference of 22nd February 2001. It should replace a number of figures that has been historically involved in home nursing: ASA - Social-Assistance Auxiliary (ausiliario socio assistenziale), OTA Assistance Technical Operator (operatore tecnico addetto all'assistenza), OSA Social Assistance Operator (operatore socio-assitenziale)and ADEST Homecare and Tutelary Services Assistant ( Assistente domiciliare e dei servizi tutelari) are some examples of figures who have been trained and employed in the homecare sector in the last years.

After that conference, each region was meant to ratify this recommendation in local laws, specifying how to manage the necessary integrative training for people who already got ASA, OTA, OSA and ADEST qualifications in order to convert them into OSS qualification. This issue has been managed at local level in different ways, so at national level there’s no uniformity about the training paths followed by these professionals. A social-health operator is a qualified professional whose job description centres on meeting the main needs of a patient, in a social or health care setting, by promoting the patient’s autonomy and welfare. A social-health operator’s main tasks focus on the assisted and his/her environment. They include:

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a) direct assistance and domestic help; b) hygiene/health-related help and social support; c) educational and management support. Social-health operators work within the framework of social services or healthcare services (in residential, or semi-residential facilities, in hospitals or in the users’ own houses). Regions are in charge of providing the training for social-health operators, in accordance with the existing rules and regulations. The regional and independent provincial authorities accredit local healthcare agencies, hospitals and public or private organisations (provided that these meet the requirements laid down by the Ministry of Heath and the Department of Social Affairs) to carry put the training courses.

ROLE (SET OF

ACTIVITIES)


factual knowledge



ENVIRONMENTAL MONITORING

Basic knowledge of home environment safety Basic knowledge of hygiene: personal hygiene, home environment hygiene, health care operator’s hygiene Knowledge of the general provisions applying to workers’ health protection and safety

Being able of identifying home environmental health risks Being able of guaranteeing home environment hygiene and safety conditions and care (home cleaning, food, etc.) Being able of acting in order to reduce risk levels

Implementing safety procedures in home environments Implementing environmental sanitisation procedures Performing activities aimed at assuring personal hygiene, fulfilment of physiological functions, proper use of health aids and devices, proper positioning and postural behaviour Adopting specific procedures to ensure elderly patients’ safety by reducing risks at a minimum

HEALTH MONITORING

Knowledge of elements of anatomy and physiology Knowledge of elements of pathology Knowledge of elements of psychology and sociology

Being able of applying the various steps for customised interventions Being able of detecting and reporting elderly-related general and specific problems

Implementing procedures to monitor non self-sufficient elderly’s psychophysical health Adopting communication strategies with elderly patients Implementing medical and health procedures

Deliverable 2.1


ROLE (SET OF

ACTIVITIES)


factual knowledge



Knowledge of the main indicators of risk conditions related to psychophysical pathologies

Being able of detecting risk conditions and the most common syndromes of bedridden and immobilised elderly patients Being able of supplying basic elements of health education to elderly patients and their relatives

Implementing procedures to ensure the proper assumption of the prescribed medicines Implementing supporting procedures to assist with the mobilization, ambulation and transport of non self-sufficient elderly patients Implementing checking procedures for socio-sanitary interventions

EQUIPE WORK Knowledge of social and health care procedures

Being able of interacting with social and health service organisations and informal health networks

Implementing teamworking strategies Involving informal networks, and establishing relationships with local social and cultural facilities and recreational centres Adopting common working procedures, records, protocols, and implementing schemes to detect non self-sufficient patients’ psychophysical requirements in collaboration with other professional figures

ADMINISTRATIVE SUPPORT

Knowledge of elements of labour law and employment status Knowledge of elements of health legislation and health services organisation

Being able of understanding management, organisation and training strategies Being able of using information technology tools to record health care-related data

Using information technology tools to record data related to health care treatments

DAILY LIFE ACTIVITIES

Knowledge of psychological and relational dynamics and health care procedures to meet elderly patients’

Being able of adopting the proper social and health care strategies with elderly patients with different

Implementing procedures to support elderly’s social integration

Deliverable 2.1


ROLE (SET OF

ACTIVITIES)


factual knowledge



specific needs Knowledge of elements of ethics and deontology Knowledge of elements of household administration Knowledge of socialising patterns

degrees of psychophysical loss of autonomy Being able of establishing the proper interpersonal relationships with suffering, disoriented and distressed elderly patients Being able of providing home or residential care to elderly patients with different degrees of psychophysical loss of autonomy Being able of promoting socialisation activities

Staging entertainment activities for elderly patients Implementing technical procedures to help non self-sufficient patients get dressed and take care of their clothing Supporting non self-sufficient patients with food intake Establishing good relations with elderly patients and their families by actively interacting in all daily care activities Performing professional activities ethically and discreetly

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8.5.7 Homecare assistant / home helper

The Homecare Assistant is the main figure who provides social homecare / home aid to older adults. This figure is not included in the legislation of all regions (sometimes it is called Home Assistant or Family Help and its profile varies slightly). Despite this, this role has become more and more significant, especially because there is an ever growing number of social co-operatives which provide assistance to minors, the elderly and the disabled on behalf of councils. The employment relationship for this figure is laid out in CONTRATTO DI LAVORO DOMESTICO C.C.N.L. (Domestic Labour Contract – Collective bargaining agreement) which is valid from 01/07/2013 to 31/12/2016 Every region has its own official registry for family assistants, the requirements for which vary from region to region, especially in terms of training, ranging from a minimum of 32 hours to a maximum of 300 hours. Some regions requires assistants to provide proof of one-year experience. The training courses cover different amounts of content due to the different course length. In general, they all cover topics such as domestic chores and domestic hygiene, personal hygiene, meal preparation, environmental safety, coordinating social and health services. A person can apply to be included in the official registry if he/she: � is over 18; � has completed compuslory education � has never been convicted of a crime which relates to professional standards, pursuant to art. 44 of the criminal code ; � is medically fit; � has undergone the relevant training or can provide he/she has already worked as an assistant for at least one year

Non-EU citizens need to provide a valid residence permit for paid employment and prove they have an adequate mastery of Italian.

ROLE5

(SET OF ACTIVITIES)

KNOWLEDGE

know what - theoretical and/or factual knowledge

SKILLS


COMPETENCIES

know how to be

PATIENT CARE AND SUPPORT

Psychophysical characteristics of people with different levels of self-sufficiency

Basics of food education and dietary therapy Implement food preparation techniques

Basics of food hygiene

Basics of sanitary education

5 Regione Liguria Professional Repository – Homecare Assistant Competencies http://professioniweb.regione.liguria.it/Dettaglio.aspx?code=0000000117

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ROLE5

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Basics of socio-educational assistance, with reference to private standard services

Basics of Ethics in personal services

Basics of residual abilities management Implement non-self-sufficient user psychophysical need survey techniques

Implement support techniques for non-self-sufficient user in keeping residual abilities and in functional rehabilitation

Basics of personal hygiene Implement support techniques for non-self sufficient users’ personal hygiene

Implement active and shared communication techniques with non-self sufficient user

Implement support techniques on prescribed med taking

Implement support techniques during meals for non-self sufficient users

Implement support techniques to help non-self-sufficient users with their bodily fucntions

Implement support techniques for non-self-sufficient user in moving, walking, carrying

Implement support techniques for non-self-sufficient user in dressing and grooming

KEEPING CLEANING AND SAFETY

Basics of environmental hygiene Implement environment cleaning techniques

Use equipment for environment cleaning

Deliverable 2.1


ROLE5

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

CONDITIONS IN DOMESTIC ENVIRONMENTS

Use products for bathroom fixture cleaning

Use products for room cleaning

Basics of personal hygiene Implement hygiene techniques for user’s linens

Safety and prevention in domestic environments

Implement safety procedures in domestic environments

8.5.8 Social Guardian

In Italy regions manages autonomously social services and in particular interventions for older adults in community.

In some regions, specific figures manages services aimed at fostering older adults independent living, monitoring situations of fragility and empowering mental, physical

and relational resources of the individual. This figure, who often attend a short course for being qualified, takes different names in different regions.

In this report is presented the figure identified by Regione Liguria, the Social Guardian.

He/she makes home visits or telephone calls, gives support in mobility, accompanies the older adult when going out (for shopping, visits or administrative tasks) and

monitors his/her health status in order to avoid risky situations. The Social Guardian plays a complementary role with respect to the home aid provided by municipalities

by monitoring frailty situations, activating territorial networks around lonely people and contributing to the reduction of improper institutionalizations.

In Liguria, the Social Guardians are professionals coming from the social cooperation world, without a specific qualification, but practically trained (very short course) to

perform the envisaged tasks.

Deliverable 2.1


ROLE 6

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

ENVIRONMENTAL

MONITORING

to know the basics of home environment

safety

to report an environmental risk (to whom,

how, with what times)

to evaluate a safety risk in home

environment

to know the basics of hygiene in home

environment (cleaning, food etc.)

to report an hygiene risk (to whom, how,

with what times)

to evaluate an hygiene risk in home

environment

to take actions to reduce the risks

HEALTH MONITORING to know the main indicators of risk conditions for physical and mental health

to report an health risk (to whom, how, with what times)

to evaluate an health (mental and physical) risk in home environment

to take actions to reduce the risks

EQUIPE WORKING

to know the network of services which can support older adults at local level

to address the older adults to the main existing services which can improve his/her quality of life

to evaluate the usefulness / necessity of activating a service

to activate formal and informal support to stimulate active and healthy lifestyle

to build a network around the older adult working with medical social worker, neighbors and volunteers


to know the basics about the administrative practices related to aging management

to support older adults in compiling fiscal practices and other administrative practices

ACTIVITIES OF DAILY LIVING SUPPORT

to know the basics of domestic economy to go grocery shopping to evaluate the proper foods to be bought on the basis of economic

6 Sources: 1. Agorà Social Cooperative – Social Guardian Job Description;

2. Genoa Municipality Website – Social Services – Interventions for older adults in community http://www.comune.genova.it/pages/interventi-di-comunit%C3%A0-anziani-0 3. Law - Delibera Giunta Regionale N° 218/2012

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to know the basics of nutrition principles availability and food needs

to know the basics of physical and mental conditions of older adults during

accompaniment (falls risk assessment)

to accompany in the proper way the older adult when going out

to know the basics of social participation process

to promote older adults social

participation relying on his/her network and/or expanding it

8.5.9 References

Boerma, Wienke, et al. Home care across europe. Case studies. Ed. Nadine Genet. London, UK: European Observatory on Health Systems and Policies, 2013.

Colicelli C., La domanda di assistenza sul territorio e l’out of pocket delle famiglie: quali prestazioni di tipo infermieristico, XVII Congress of Federazione Nazionale Collegi

IPASVI, March 2015 http://forumbm.it/forum/wp-content/uploads/2015/03/Intervento_Carla_Collicelli-1.pdf

Genova A., Le disuguaglianze nella salute, Carocci, Roma, 2008

Lamura G., Principi A., 2009a. L’ indennità di accompagnamento. La suddivisione della spesa tra sociale e Sanitario. Giornate della Ricerca Sociale – Roma, 25 giugno

2009, “Il sistema di protezione e cura delle persone non autosufficienti. Prospettive, risorse e gradualità degli interventi”. Progetto promosso dal Ministero del Welfare,

http://www.istitutodeglinnocenti.it/ eventi/pdf/roma_220609.pdf;jsessionid=AB6157AB5144061A49 8FEAA9325D0F86

Maciocco G. & Scopetani E. eds., Diseguaglianze nella salute. Lo stato dell’arte, in “Prospettive Sociali e Sanitarie” n. 11- 12/2010

Merotta V., l ruolo delle assistenti familiari nel welfare italiano, Report Fondazione ISMU – Iniziative e studi sulla multietnicità, May 2016 http://www.ismu.org/wp-

content/uploads/2016/05/Merotta_Assistenti-familiari_paper_maggio2016.pdf

Law 328, 8.11.2000. “Legge quadro per la realizzazione del sistema integrato di servizi e interventi sociali” (Framework law on social services),

http://www.camera.it/parlam/leggi/00328l.htm

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Law PSIR 2013/2015 (Regione Liguria) (Health and Social Services Regional Integrated System)

Law DGR N 446/2015 (Regione Liguria) - Health and Social Services Integrated System

EUROSTAT http://ec.europa.eu/eurostat

IRS-Soleterre, 2015, Lavoro domestico e di cura: pratiche e benchmarking per l’integrazione e la conciliazione della vita familiare e lavorativa, Report finale, marzo,

http://www.soleterre.org/sites/soleterre/files/soleterre/dettaglio/pubblicazioni/RAPPORT OLAVORODOMESTICOeDICURA_2015_SOLETERRE_IRS.pdf.

ISTAT – Italian National Statistics Institute http://www.istat.it/it/

Ministry of Health 2007 – Department of Quality – National Commision for the definition and the update of the Essential Levels of Assistance (LEA) “Nuova

caratterizzazione dell’assistenza territoriale domiciliare e degli interventi ospedalieri a domicilio” (New definition of home nursing),

http://www.ministerosalute.it/imgs/C_17_pubblicazioni_772_ allegato.pdf, searched 10.03.2010.

Italian Ministry of Health, 2010, http://www.ministerosalute.it/esenzioniTicket/esenzioniTicket.jsp

Italian Health Ministry - February 22nd 2001 Agreement “Accordo tra il Ministro della sanità, il Ministro per la solidarietà sociale e le Regioni e Province autonome di

Trento e Bolzano, per la individuazione della figura e del relativo profilo professionale dell’operatore socio-sanitario sanitario e per la definizione dell’ordinamento

didattico dei corsi di formazione”, Official Gazette 1April 19th 2001. http://www.ipasvi.it/archivio_news/leggi/175/ACC220201.pdf

Pesaresi F. 2007. “Le cure domiciliari per anziani in Italia” (Home nursing care for elderly in Italy) in Prospettive sociali e sanitarie vol. 37 n. 15

Pesaresi F. 2007a. “Il SAD per anziani in Italia” (Home help care for elderly in Italy) in Prospettive sociali e sanitarie vol. 37 n. 18.

Pesaresi F., 2010. Prestazioni e servizi sociosanitari. La normativa nazionale, http://www.grusol.it/corsi/2%20

pesaresi%20integrazione%20ss%202010%208%20marzo.pdf, searched 01.04.2010

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9 OLDER PERSONS HOMECARE IN SPAIN

9.1 Overview on the older persons homecare service in Spain

Why homecare is a basic need in Spain?

It is a fact that Spanish population is a progressively aging, since nowadays people tend to live to older ages,

and this increases the number of long-term old age dependents. When people analyze their choices in finding

a way to be assisted in this situation of dependency, they realize that hospitalization and nursing homes often

are not adequate options due to the fact that expenses are very high. In the past dependents resorted to their

family and friends when in need, but due to changes in family relationships and in informal support (provided

by family, friends…) this is no longer an option for most of them. Finally, when asked they express their

willingness to stay at home as a personal choice.

Homecare in Spain

There are two sides to the services provided at home to long-term old age dependents in Spain: health and

social services.

HOME NURSING SERVICE

This is a group of activities –previously planned- developed by professionals who are part of a multidisciplinary

nursing team. The aim of this team is to provide health services by means of a series of activities which have to

do with promotion, protection, healing and rehabilitation. These services are provided within a frame of joint

responsibility of the patients and/or their family with the professionals of the nursing team. They are provided

at the patient’s home when, due to their health conditions or to other criteria previously established by the

team, they cannot get about.

HOME SOCIAL SERVICES CARE

This service is aimed at that group of the population with great limitations to do their daily chores, being this

temporary or permanently. They help them in improving their personal autonomy and their quality of life

within their environment.

Among others, the users of this service are dependant elderly people, and thus they have limitations in their

personal autonomy. The service may vary, and they may provide homecare, tele-home care services, catering,

laundry, funding to adapt their home for accessibility, technical assistance, etc.

How do laws regulate these homecare services in Spain?

Here we include a summary of the most salient laws referred to homecare health and social services:

• Law 14/1986, 25 April, Act on the General Health System

• Law 16/2003, 28 May, cohesion and quality of National Health Services

• Royal Decree 1030/2006, 15 September, in which the General Health System common services

portfolio and the procedure for its updating are established.

• Law 39/2006, 14 December, to promote the personal autonomy and attention to dependents.

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• Resolution of April 23 2013, Social Services and Equality Secretary of State. Agreement of the Social

Services Regional Council and of the System for the Autonomy and Dependency Attention on criteria,

recommendations and minimum requirements for the development of prevention plans on

dependency situations and personal autonomy; basic data of the information system of SAAD and

Social Services Reference Catalogue.

• Royal Decree 1051/2013, 27 December, regulating the benefits of the System for the Autonomy and

Dependency Attention, established in the Law 39/2006, of 14 December, to promote the personal

autonomy and attention to dependents.

• Royal Decree 291/2015, of 17 April, modifying the Royal Decree 1051/2013, of 27 December,

regulating the benefits of the System for the Autonomy and Dependency Attention, established in the

Law 39/2006, of 14 December, to promote the personal autonomy and attention to dependents.

• Guide for clinical homecare good practices. Organización Médica Colegial (Collegiate Medical

Organization) and Ministry of Health. 2005

• Strategy for patients with chronic and polypathologic diseases care. 2013

9.2 Report on primary data about homecare service in Spain

Who are responsible for the provision of homecare health and social services?

Again we classify this information into two groups, health services and social services.

Home nursing service

• Home nursing services are carried out nationwide, basically, by Primary Care doctors and nurses in two

ways: on demand or by scheduled attention.

• Other homecare strategies are developed to a greater or lesser extent depending on the

Autonomous Regions, and this will depend in two factors, the specialized attention given and

the primary care give:

• Depending on the specialized attention given:

• Home Hospitalization Units.

• Depending on the Primary Care given:

• Homecare Sanitary Teams.

• Terminal and Immobilized Patient Service.

• Continuous Care Units.

• Family Carer Attention Service.

Social Services Homecare

In Spain there are three administrative levels responsible for the provision of social services homecare, the

State Administration, the Autonomous Regions and the Local Councils:

� State Administration. They are only competent at a basic legislative level. The Imserso

[Elderly and Social Services Institute] is the body responsible for this.

� 17 CCAA [Autonomous Regions]. They have a main managing competence in terms of social

services assistance. They have a total legislative capacity and the main executive functions.

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� Local Councils. They are competent in terms of managing basic social services, no matter

which administration finances them. Both local and autonomous administrations partly

finance benefits, compensations and services through a complex scheme which varies from

one Autonomous Region to another.

In order to gather the primary data referred to the practitioners – both formal and informal –involved in

elderly homecare, we have passed a questionnaire created ad hoc for this purpose.

The sample of people interviewed corresponds to 105 care providers, 81% of whom have been working with

elderly people for the past five years. Out of all the care providers interviewed, 41% were homecare providers

or homecare assistants, 19% were auxiliary nurses, 6% nurses and 31% of the respondents marked the box

other.

When asked about the type of institution they worked for, 57% belonged to a public institution, 14% worked

for a private company, 14% were self-employed and 14% of the respondents marked the box other. On an

average respondents were born in 1970.

The tasks which these homecare providers more often carry out are, among others, elderly needs assessment,

home treatments -such as taking blood samples, supervision for healthy life styles or team meetings and

contacts with other professionals related to elderly care.

71% of these care providers usually stay for 15’ to 30’ in each client’s home, whereas 14% of them do so for

30’ to one hour. They usually, in 71% of the cases, visit these people once a week, and two or three times a

week in 14% of the cases.

When they were asked about the needs of the elderly they usually have to deal with, their responses are the

following: 71% of the times they need to be very respectful with the values the elderly more cherish –including

religious beliefs and spiritual needs. 57% of the respondents comment on their need to try to prevent skin

lesions by providing elderly with an adequate hygiene, repositioning and taking good care of the skin; care

providers also need to be instructed on repositioning in order to avoid provoking bedsores and pressure sores;

they also need to be educated in the specific care to be given to urinary and fecal incontinent patients; they

need to be trained in helping elderly in developing a strict discipline in complying with non-pharmacologic

treatments, including active and healthy lifestyles, such as adherence to prescribed diets, control of food

consumption, exercising; finally, 43% of the people interviewed comment their need to be supported in

supervising self-controlling physical health, in rehabilitating elderly physiological habits and in overseeing

adherence to treatments –such as preparation of dosage, revision and adjustment of new doses, etc.

If we exclude nurses from the care providers interviewed, 44% of the resulting group work for a public

institution and 39% for a private one. On an average respondents were born in 1973.

As for the tasks these care providers more often have to carry out, among others, they need to assess their

clients needs. They also have to take care of the personal hygiene of the elderly as well as help them in their

everyday activities. Finally they need to supervise they have healthy life styles.

31% of these care providers stay at their clients’ home for 1-2 hours, and 35% of them stay from 30’ to one

hour. 46% of the respondents usually visit the elderly once a week, and from 3 to 5 times 24% of them.

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When asked about the tasks they need to take care of during their daily activity, 69% of them assist elderly in

their personal hygiene –taking a shower or bath, cleaning their teeth, etc; 60% of the respondents regularly

help clients dressing up and also moving around at home; finally, 56% of care providers help elderly in their

house cores, i.e. cleaning, tidying up, doing the washing, ironing and organizing their laundry.

We enclose, together with this document, a table in which information obtained from secondary sources has

been gathered. This has been arranged in terms of the different categories implied.

Who pays for homecare in Spain?

As we have done before, we will first analyze this aspect in terms of the health services provided and then in

terms of the social services.

Nursing Services: In Spain the health system is provided almost universally by the National Health Service but

individuals can also purchase private healthcare. Let’s explain this in more detail.

• Public Health System

The health coverage is almost universal and tax-financed: A transfer in made from the national budget

to the different Autonomous Regions.

The Autonomous Regions may increase their expenses through some special items, these costs being

assumed by the region’s budget.

• Private Health Insurance

This is a type of medical and nursing care provided by insurance companies that users can privately

subscribe.

• Philanthropic/ Community service

Exceptional assistance on medication control, enteral feeding…

Social Services: In this country social services are run by the administration at three levels, State

Administration, Autonomous Regions and Local Corporations (City Councils and Provincial Councils).

The State Administration contributes to this funding through the agreed Social Security (SS) Plan,

created in 1988, with the aim of developing and strengthening the SS basic network, and reducing the

irregularities in the offers. This Plan is structured in different collaboration agreements signed

between the State Administration and the Autonomous Regions (except for the Basque Country and

Navarra). The Autonomous Regions agree to pay, at least, the same amount of money as the State

Administration.

Since the Dependency Law 39/2006 became effective, priority has been given to its funding (it is co-

financed by the State Administration and the Autonomous Regions). This law takes into account a wide

array of services and benefits, one of them being SAD (Homecare service)

This System for Dependency Attention is co-financed by:

� the State Administration

� the Autonomous Regions: agreeing to pay, at least, the same amount of money

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� Dependent patients: in line with their financial resources

The management of SAD can be hired with a private company.

Homecare: tasks and activities

Sanitary Services

• Attention to patients in acute phase

� Medical patient monitoring and acute illness control, as frequently as needed. Follow-up as

required.

� Nursing attention

• Attention to patients with chronic illnesses

� Nursing attention: follow-up, signs and symptoms control, treatment control, treatment compliance, specific treatments (treatment of pressure ulcers), catheter care, control and replacement (SNG, PEG, S.V.) etc...

� Medical attention

• Post clinical attention

� Medical and nursing follow-up care.

E.g.: ongoing care for pluripathological patients

• Geriatric attention

� Medical and nursing homecare provided to elderly patients

� Medical and nursing provided to elderly patients in a residence after being dismissed from

hospital.

• Palliative care

� Medical and nursing care to control symptoms, medication and special techniques

(paracentesis...)

• Home hospitalization

� Patients with chronic pathologies requiring complex medical or nursing techniques (such as

dialysis, intravenous feeding or non-invasive mechanical ventilation) are in need of informal

support (provided by family, friends…) and/or sufficient social coverage. The social coverage

can be updated when the medical assistance is given.

Social Services

� Personal Attention Service

o Personal care (persona hygiene, dressing, food, personal appearance…)

o Help in getting up or getting in bed, help in mobility, in moving around the house and

when going out from home.

o House chores support.

o Sociosanitary activities (supervision in medicines intake, supervision in adequate diet

intake,…)

o Assistance in personal paperwork.

o Teaching how to do different household chores.

� Tele-home care services

� Home-delivered meal services

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� Home-delivered laundry services

� Home cleaning services

� Home hairdressing services

� Home chiropody services

� Support to carers

� Education and involvement with family, and promotion of personal autonomy.

� Technical assistance to improve home accessibility.

9.3 HHCP involved in older persons homecare service in Spain: roles and

competences

The homecare profession

Education of HHCP:

In Spain, as already stated, we can classify HHCPs into two groups: informal practitioners (with no previous

training) and formal practitioners (those who have previous training in care, the type of training raging from

professional qualifications to university training).

The professional qualifications in Spain have been categorized in the Professional Qualifications National

Catalogue (CNCP), they are arranged in terms of professional groups, and in terms of level of qualification,

following the EU requirements. These constitute the base to develop the titles and certificates of professional

qualification offered.

The CNCP includes the content of the VET associated to each qualification, according to a structure of

articulated formative units.

EU and national framework of qualifications:

The correlation of the Spanish framework with the EQF is done through the Spanish Framework of

Qualifications (MECU) or National Qualification Framework (NQF), which includes all the levels, from level 1

(primary education) to level 8 (University Doctoral Studies).

As can be see in the table, the MECU is the result of the addition of the CNCP and the Spanish Qualifications

Framework for Higher Education (MECES).

These specifications are presupposed at level 3 of CNCP, corresponding with level 1 of MECES and with level 5

of EQF, establishing as Higher Education the one corresponding to the degree of Técnico Superior de

Formación Profesional (VET Upper Level Technician).

Problems faced by the homecare profession

One of the problems that homecare has to face is that specialized sanitary homecare and homecare

professionals are still scarce in the labor market (there is a lack of occupational therapists, psychologists,

nursing assitance, psychiatric attention, physiotherapists, psychomotor activity). Also, more financing should

be allotted to better prepare these professionals and to better help those in need, e.g. a quicker and more

immediate attention should be given, there should be a better response capacity –a variety and adequacy of

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services and benefits. Professionals should also be more flexible to adapt to changes. Besides, there are great

difficulties in maintaining the present system and there should be a better sociosanitary coordination.

As for the conditions in which many elderly live, there is a need for homes to be adapted to the patient’s new

requirements.

Customers

Homecare sanitary services users

• Elderly who, due to their health condition or to other criteria previously established by the team,

cannot get about.

Homecare social services

• Elderly with limitations to get around in their everyday life, with difficulty in their personal autonomy,

dependent.

NURSES (EQF 6):

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS

know how to do - SKILLS as cognitive and

practical

COMPETENCIES

know how to be

RESPONSIBLE FOR

GENERAL CARE.

■ Know and identify the structure and function of the human body.

■ Understanding the molecular and

physiological bases of cells and tissues.

■ Understand the use and indications

of health products linked to nursing

care.

■ Know the different groups of

medicine, their authorisation

principles, the use and guidelines, and

their action mechanisms.

■ Know and asses the nutritional

needs of healthy people and people

with health problems throughout the

life cycle, to promote and strengthen

guidelines/patterns of healthy eating

behaviour.

■ Identify nutritional problems of

higher prevalence and choose the

appropriate dietary recommendations.

■ Know the pathophysiologic

processes and its

symptoms and risk factors that

■ Use of medication, evaluating the

expected benefits and the associated

risks and/or effects of its administration

and consumption.

■ Identify the people’s psychosocial to

different health situations (in particular,

disease and suffering), choosing the

adequate actions to provide help in

them.

■ Establish an emphatic and respectful

relationship with the patient and family,

consistent with the person’s situation,

health issue and development stage.

■ Use strategies and skills allowing an

effective communication with patients,

families and social groups, as well as

expressing their concerns and interests.

■ Recognise life-threatening situations

and know how to perform basic and

advanced life support manoeuvres.

■ Apply the nursing procedure to

provide and guarantee welfare, quality

■ Ability to work in a team.

■ Ability to apply critical

thinking.

■ Capacity for analysis and

synthesis.

■ Capacity to assume an ethical

commitment.

■ Ability to properly

communicate verbally and non-

verbally and stablish

interpersonal relations.

■ Ability to recognise diversity

and multiculturalism.

■ Ability to apply knowledge

into practice.

■ Ability to solve problems and

make decisions.

■ Ability to work on the basis of

quality criteria.

■ Ability to develop creativity.

■ Ability to develop initiatives

and entrepreneurial spirit.

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determine health status and diseases

in the different stages of the life-cycle.

■ Know and identify physical and

psychological problems derived from

gender-based violence in order to train

the student in prevention, early

diagnosis, assistance and rehabilitation

to victims of this form of violence.

■ Know and apply the principles

based on comprehensive nursing care.

■ Understand the changes connected

to the process of ageing and its impact

on health.

■ Know the health issues that are

more common in elderly people.

■ Know the Spanish healthcare

system.

■ Know and be able to implement

team leadership techniques.

■ Know the applicable law and the

Spanish nursing code of ethics ad

conduct, inspired in the code of ethics

and conduct for European nursing.

■ Know the most relevant mental

health issues in the different stages of

the life cycle, providing comprehensive

and effective care within nursing.

■ Know the palliative care and pain

and safety to the people attended.

■ Manage, assess and provide

comprehensive nursing care for the

individual, the family and the

community.

■ Ability to describe the health

primary level bases and the activities to

be developed to provide

comprehensive nursing care for the

individual, the family and community.

■ Promote the involvement of people,

families and groups in the health-

disease process.

■ Identify the factors associated with

the health and environmental issues to

care for people in health-disease

conditions as members of a community.

■ Identify and analyse the influence of

internal and external factors in the level

of health of individuals and groups.

■ Analyse statistical data referred to

population-based studies, identifying

the possible causes of health problems.

■ Educate, provide and support

members of the community’s health

and welfare, whose lives are affected by

health problems, risk, suffering, illness,

disability or death.

■ Ability in leadership.

■ Ability to learn.

■ Ability to plan and evaluate.

■ Ability to adequately use IT

resources and emerging

technologies.

■ Ability to demonstrate

research skills.

■ Ability to develop information

management skills.

■ Ability to communicate in the

mother tongue.

■ Ability to communicate in a

second language.

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control to provide care that alleviates

the condition of advanced and

terminally ill patients.

■ Identify the nutrients and the food.

■ Identify people’s psychosocial

response to different health situations

(in particular, disease and suffering),

choosing the adequate actions to

provide help in them.

■ Identify the different characteristics

of women in the different stages of the

reproductive cycle, the climacteric and

the alterations that may occur

providing the necessary need at each

stage.

■ Identify the care needs derived from

health problems.

■ Carry out nursing care techniques

and procedures, establishing a

therapeutic relationship with the

patients and their families.

■ Choose interventions aimed at

treating or preventing problems derived

from health deviations.

■ Have a cooperative attitude with the

different team members.

■ Identify structural, functional and

psychological changes and ways of life

associated with the process of ageing.

■ Choose the carers intervention

aimed at treating or preventing health

problems and their adaptation to daily

life by proximity and support resources

for the elderly person.

■ Identify the characteristics of the

lead role of nursing services and care

management.

■ Provide care, guaranteeing the right

to dignity, privacy, intimacy,

confidentiality and decision-making

capacity of the patient and family.

■ Individualize the care taking into

account: age, gender, cultural

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SOCIALAND HEALTH CARE FOR PEOPLE AT HOME

differences, ethnic group, beliefs and

values.

■ Develop communication, clinical

reasoning, clinical management and

critical judgment techniques;

incorporating in the professional

practice the knowledge, skills and

attitudes of Nursing based on the

principles and values associated to the

skills described in the general objectives

and courses that make up the Degree.

■ Implement health care information

and communication technologies and

systems.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


practical

COMPETENCIES

know how to be

� Domestic service assistant.

� Home care assistant.

� Home hygiene and health care.

� Home care and psychosocial support.

� Home support and family meals.

� Observe and communicate with the dependent person to identify the need for transmitting any health information.

� Adapt and apply personal hygiene and

� Carry out physical home care actions aimed at people with socio-health care needs (UC0249_2).

� Carry out psychosocial home

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� Elderly,

disabled or convalescent home care worker.

� Practical training at the workplace in

Social and health care for people at home.

bed making techniques at home, selecting commonly used products, materials and utensils, according to the state of the dependent person and the type of technique to be applied.

� Use movement, mobilization, walking and positioning techniques on the dependent person according to the level of dependence.

� Execute prescriptions for administering medication orally, topically or rectally, as well as local heat and cold treatments; deciding on and organizing the material that must be used according to the technique demanded and the prescription.

� Apply techniques to assist in eating and drinking and collection of excretions according to the level of dependence of the person, following the prescribed indications.

� Collaborate on the personal assistance

and psycho-social support of dependent people and their family environment, applying criteria and strategies that promote their personal autonomy.

care actions aimed at people with socio-health care needs (UC0250_2).

� Carry out activities related to

the management and operation of the household unit (UC0251_2).

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PHYSIOTHERAPISTS:

Implementation. The public system offers these therapies in units, services and specialized Medical and from “Primary Health Care” centres.

Since 1991, Physiotherapy has been legally integrated in “Primary Health Care”. In 2006 the Common Service Portfolio of the National Health System was stablished. The physiotherapy activities that are implemented in accordance with the programmes of each health service are those that could be carried out in the primary health care, on an outpatient basis, prior medical advice, including home health care by clinical circumstances or by accessibility limitations. The type of assumable activity in the old people’s home is described in the box “OCCUPATION” below.

The physiotherapy centres can be public or private stated-assisted centres. Private procurement of physiotherapy at home is allowed.

� Prepare a work plan in the home, adapting actions to the needs of the household unit.

� Organize and buy food, household

goods and other basic products for use at home daily or weekly.

� Apply basic cooking techniques to make meals, according to the characteristics of the members of the family unit.

� Carry out the cleaning, maintain order and make small repairs in the home.

� Take part in the company's working processes, following the rules and instructions established at the workplace.

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


practical

COMPETENCIES

know how to be

� Prevention of development of progress of musculoskeletal disorders. � Physiotherapy

treatments to control the symptoms and a functional improvement in musculoskeletal chronic processes. � Recovery from

minor musculoskeletal severe processes � Physiotherapy

treatment in neurological disorders. � Chest

physiotherapy. � Health guidance

and training for the patient or carer.

� Know and understand the morphology, physiology, pathology and behaviour of both healthy and sick people in the natural and social environment.

� Know and understand the sciences, types, techniques and tools on which physiotherapy is based, articulated and developed.

� Know and understand the physiotherapeutic methods, procedures and proceedings aimed to be both therapeutic itself to be implemented in the clinic for functional rehabilitation or retraining, and to the execution of activities targeting health advocacy and maintenance.

� Practical skills, knowledge of ethical and professional values of an administrative and organisational context and of the legal principles of the profession. That they are known and are able to implement both on specific clinical studies in the hospital setting and for outpatients, as in the primary health care and community care proceedings.

� Carry out Medical History of Physiotherapy.

� Examine and assess the functional state of the patient/customer.

� Establish the Physiotherapy diagnostic. � Provide effective and comprehensive

care. � Assess the development of results � Elaborate the physiotherapy medical

discharge report.

� Interact in an effective way with the multidisciplinary team.

� Conform to the limitations of their professional competence.

� Show respect towards the work of others.

� Spread the ability to motivate others.

� Incorporate ethical and legal principles and the social and community aspects in decision making.

� Update the knowledge, skills and attitudes.

� Sustain a learning attitude. � Focus the performance on evidence-

based practice. based � Express a high degree of self-concept.

� Design, management and implementation of the physiotherapy intervention or treatment.

� Coordination of the Physiotherapy Intervention Plan.

� Cooperation with other professionals.

� Physiotherapy services management.

� Development of quality in the practice of physiotherapy.

� Elaboration of care protocols.

� Intervention in the field of development, prevention, protection and health recovery.

� Incorporate scientific research into

the own sphere of the

physiotherapy field.

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� Position the patient/customer un the

centre of the actions. � Intervene in protection and promotion of

health. � Intervene in disease prevention. � Show discretion.

OCCUPATIONAL THERAPISTS

The majority of specifications that are described below are described for the occupational therapist degree that are general for all the education plans in Spain.

Some specifications have been removed since they will no longer be taken into account in a home environment for elderly people.

Implementations: The public system offers these therapies in units, services and specialised centres. The care at home often arises from the need to adjust the

strategies and skills in the real environment of the patient, during the transition of medical discharge from medical short-stay units, medium-stay and long-term

stay. In any case, this care at home is scarce or a bit more frequent from the private sector.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


practical

COMPETENCIES

know how to be

The one specific of

occupational

therapy

� Interventions in geriatric rehabilitation.

� Interventions in Mental Health

rehabilitation.

� Interventions in intellectual disability.

� Interventions in neurological

rehabilitation.

� Interventions in physical rehabilitation.

� Assess the abilities and the individual’s

physical, psychological, sensory and

social problems.

� Develop treatment plans and training to

attain the highest level of independence

and autonomy possible in daily life.

� Carry out, assess and register

� The promotion of Health and

Welfare through the professional

activities.

� Planning of specific treatments of

the profession, independently or in

coordination with other

professionals.

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� Interventions in psychosocial

rehabilitation.

� Interventions in palliative care.

� Interventions in burns.

empowerment and training tasks.

� Practice intervention using techniques,

procedures, methods and models,

through the use of the profession in the

environment.

� Adapt the environment.

� Recommend and adapt support

products.

� Adapt technical aid, orthoses and

prostheses.

� Implement routines and planned habits

that facilitate the recovery or

development of new roles.

� Implement the knowledge and

proceedings in the inpatient, outpatient

ad community settings, whether it is

through health care, social care or social

health care.

� Forward information, ideas, issues and

solutions to both customers and

specialised people.

� Focus and emphasize the intervention of

family members and carers in the “task

facilitating role” of the person in order to

avoid “the person’s substitution in the

performance of tasks”

� Ability to gain new knowledge and skills.

� Empowerment of the individuals to

conduct those tasks that enhance

the ability to participate,

contributing to recovering from

their disease and/or facilitating their

adaptation to their disability.

� Change of the environment so it can

strengthen the participation.

In teaching and research:

� Training for family members and

carers in

� Adaptation to the demands and

expectations of the affected person

and the family to the reality of their

daily life.

� Incorporation of attitudes and

professional and ethical values that

develop the ability to integrate the

acquired skills and knowledge.

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SPEECH THERAPY

Most of the specifications for the Degree in Speech Therapy that are included here are common to all the Spanish curricula. Orofacial-Myofunctional Therapy is of great importance in the field of neurological and neurodegenerative disorders, as well as in ageing. Mater Degrees and Specialized Courses with non official recognition are taught.

Implementation: The public system offers these therapies in specialized units, services and centers; they also offer them in non-specialized centers. Homecare resources are scarce; it is only offered on a private basis and relatives of patients need to actively look for it.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


knowledge

SKILLS


practical

COMPETENCIES

know how to be

Communication and

orofacial functions. � Expressive and/or comprehensive oral

speech functions; � Articulation and oral speech disorders

no matter what the cause is. � Reading and writing disorders.

� Tympanostomy tube disorders; � Phonation, speech and diet disorders

related to pathologies referred to

orofacial –myofunctional alterations

no matter what the cause is.

� Orofacial functions provoking

alterations in articulation and speech.

� Stimulating communicative, expressive / comprehensive oral/written speech functions.

� Orofacial –myofunctional stimulation in speech, voice, language, breathing and swallowing, derived from brain damage.

� Setting up alternative or augmentative communication systems.

� Central and peripheral facial paralysis treatment.

� Training in voice functional and/or organic alterations (presbycusis, vocal cord paralysis).

� Rehabilitation of orofacial structures and functions in tracheostomized patients and/or laryngectomees.

� Prevention, evaluation and treatment of expressive / comprehensive oral/written speech abnormalities.

� Prevention, evaluation and treatment of otorhinolaryngological pathologies.

� Prevention, evaluation and treatment of neurological diseases related to communicative pathologies and to orofacial functions.

Deliverable 2.1


9.3.1 REFERENCES

Royal Legislative Decree 1393/2007 of October 29, which establishes the organisation and planning of

official university education. (Boletín Oficial del Estado, número 260, de 30 de octubre de 2007).

Order CIN/2134/2008, of July 3, which establishes the requirements for verification of official university

degrees for the practice of the Nursing profession. (Boletín Oficial del Estado, número 174, de 19 de julio

del 2008).

Agencia nacional de Evaluación de la Calidad y Acreditación (National Agency for Quality Assessment and

Accreditation of Spain). Libro blanco. Título de grado de enfermería. Zaragoza; 2004.

10 OLDER PERSONS HOMECARE IN FINLAND

10.1 Overview on the older persons homecare service in Finland

The population in Finland is ageing more rapidly than in any other EU country. From the total 5, 487 308

inhabitants (1.4.2016) number of people aged over 65 years is 19,9 % (www.stat.fi, 11.4.2016). In addition,

Finland’s economic situation aims to economy efficient. The working age population started to decrease in

2010 and the old-age dependency ratio will be the highest of all EU countries up to 2025. This is mainly due

to longer life expectancy. People live longer but also maintain their functional abilities and independence

longer. Both of these tendencies are expected to continue in the future. (EQUIPII, 2012: 42.)

The number of clients in home care was 72 531 (November 2014), 66 % of them was women. The number

of customers rose by 0.5 per cent from the previous year. However, in Finland 11,8 % of the total number

of population over 75 years were clients in home care. 40,4 % from all clients in home care have 1 – 9 visits

during November 2013. Quarter of the clients needs more as 60 visits during a month.

(http://www.julkari.fi/bitstream/handle/10024/126302/Tk05_2015.pdf?sequence=1)

Most older people prefer to live in their own homes before institutional care (EQUIP II, p 42). Both groups,

clients and professionals, highly valued resource-based home care, including elements of encouraging and

supporting everyday activities (Turjamaa 44). Home care is more affordable and is considered to be of

higher quality than institutional care (SuPer, 2015).

The aim of Finland’s policy for older people is to promote their functional capacity and independence, with

the intention that as many older people as possible could continue to live in their own homes and their

familiar environments. Functional capacity can be maintained and improved with a range of sufficiently

early and wide-ranging preventive and rehabilitative activities. Social relations and networks of older

people are important.

The Finnish social and health policy is based on a universal welfare principle where the public sector (the

state and the municipalities) are in charge of providing well-being services for all citizens. In financing the

welfare state, Finland is undergoing a transition to a new phase due to changes in the age structure of the

population.

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Finnish homecare is regulated by following legislations and recommendations: The constitution of Finland

requires that the government guarantees sufficient social and health care services to all; The act on

Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older

Persons and by Quality recommendation.

The Ministry of Social Affars and Health is responsible for the drafting of legislation concerning home care

and home services, their general planning and guidelines. Municipalites are tasked with the organization of

social and health care services.

A good one half of municipal expenditure is used on the provision of social and health care services.

Roughly half of this is financed with taxation, a quarter with customer fees and sales and nearly a fifth with

state subsidies. One third of the statutory expenditure is covered with state subsidies. Customer fees cover

just under a tenth of the total costs.

The home care services a customer receives are based on his/her individual needs.

In Finland, municipalities have a legislative responsibility to organize home care services in collaboration

with the private and third sectors, as well as with older clients, to plan and realize home care services

consisting of support for older clients at home by offering care and services based on clients’ personal

needs (Act on electronic processing of patient documentation in social and health care 159/2007, Act on

supporting the functional capacity of the older population and on social and health services for older

persons 980/2012). The Finnish Ministry of Social Affairs and Health first published the National Framework

for High-Quality Services for Older People in the year 2001 and published an updated, more detailed

version in 2008. This framework was a new tool for informative guidance for municipalities. (EQUIPII, 2012:

43.) The municipalities are responsible for services for older people, including home care services.

Municipalities may produce services themselves or purchase them from private or third-party service

providers. Outsourcing services increase rapidly in services for older people.

1.1.2019 the system of the social and health care in Finland will change radically.

In Finland, home care services consist of three main service providers as formal care: municipal home care

services, the private and third sector (Act on supporting the functional capacity of the older population and

on social and health services for older persons 980/2012) and informal care as realized by family members.

Home care services are organized by home help service units (under social welfare) and home nursing units

(under health care) either separately or together. Home care services consist of domestic help, including

personal and physical care (e.g. meals on wheels, bathing and electronic alarm service) (Social welfare act

1301/2014), and care based on nursing (e.g. taking care of medication and wound care) (Public health act

1326/2010). New opportunities support clients and their participation to choose a server of home care.

Home care provides services for older people that support independent living at home and to maximize

clients’ resources. This requires home care services to make possible meaningful activities and social

relationships in relation to the quality of life and psychological well-being of the older client despite their

decline in functional, cognitive, psychological and social abilities and the need for the highest level of care

(Act on the status and rights of patients 1992, Act on supporting the functional capacity of the older

population 980/2012). (Turjamaa, 2014: 11-12.)

According to the current act (Act on supporting the functional capacity of the older population and on

social and health services for older persons 980/2012) in Finland, every client who regularly receives home

care services has a right to have an individual and valid care and service plan. In addition, they have a right

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to participate in decision making and decisions have to be made in agreement with older clients (Act on the

status and rights of patients 1992/785, Act on the status and rights of social welfare clients 812/2000).

Home care professionals have a legislative obligation to produce and document a care and service plan for

all home care clients (act on supporting the functional capacity of the older population and on social and

health services for older persons 980/2012, Act on electronic processing of patient documentation in social

and health care 159/2007). Professionals’ work is guided by professional codes of ethics for each profession

(The Finnish nurses association 1996, The Finnish union of practical nurses 2012). (Turjamaa, 2014: 13.)

The roles and responsibilities of the private and the third sector vary in different services. The private

sector’s care and services consist of residential homes, service housing with 24-hour assistance and home

care services realized in clients’ homes. The third sector’s care and services consist mostly of home care

services in older clients’ homes (Private health care act 152/1990, Private social services act 922/2011).

Available services are similar for all clients without acknowledging potential individual variations (Turjamaa,

2014: 13).

Care and services comprise two fields: long-term care, including 24-hour institutional care provided by

health centres and based on medical justifications (Act on supporting the functional capacity of the older

population and on social and health services for older persons 980/2012), and home care services,

including residential homes with 24-hour assistance, service housing and care and services in older people’s

homes with 24-hour or part-time assistance. In residential homes and service housing, older people live in

their own or shared rooms and can purchase services according to their needs (National institute for health

and welfare 2012b). 6.6% of municipal home care service clients received 24-hour institutional care in

Finland (National institute for health and welfare 2012b). In 2010, 8.7% of people aged 75 years or older

lived in residential homes or service housing (National institute for health and welfare 2012b). (Turjamaa,

2014: 13 – 14.)

Home care services consist of regular home visits, and the content of services is counselling and support for

self-care, everyday activities and available services. Home care professionals provide personal assistance

for everyday activities such as hygiene, eating and dressing and nursing treatments such as the

administration of drugs and wound care (Social welfare act 1301/2014). Additional auxiliary services, such

as meals on wheels, transportation and assistants, are also organized (Social welfare act 1301/2014).

(Turjamaa, 2014: 13 – 14.)

5.3% of municipal home care service clients received home care services in Finland (Official Statistics of

Finland 2013). The average age of clients in regular home care was 79.4 years and a total of 53,703 (76.2%)

clients were aged 75 or over. In most cases, the older clients’ need for home care was assistance with

everyday activities related to personal care and housing, and 64.7% received auxiliary home care services

regularly (National institute for health and welfare 2012a). Over half (51.9%) of home care service clients

received regular home visits, whereas 41.2% received between one and nine visits in one month and more

than a quarter (25.3%) of clients had over 60 visits a month (National institute for health and welfare

2012a). (Turjamaa, 2014: 13-14.)

In home care, the goal is to help, guide and support clients in coping with their normal daily activities. The

care is performed in cooperation with clients and their families at homes and in different units within the

social and health care sector. In many municipalities, home care services are provided 24 hours every day.

Good communication, interaction and ethical skills are required in home care work, along with domestic

and nursing skills. It underlined the primacy of promoting health and welfare, of giving priority to

Deliverable 2.1


prevention and support for home living, and of the comprehensive assessment of individual needs. (EQUIP

II, 2012: 42.)

Older people’s home care services are realized in clients’ homes by home care professionals

(practical nurses, home care nurses, public health nurses and home care service managers) in collaboration

with other social and health care professionals. Most of the home care workers are practical nurses.

Altogether there are 25 000 home care workers in Finland, almost 99 % of them are women (EQUIP II,

2012: 42.)

Approximately 130,000 people in Finland have a cognitive disorder and 40,000 of them are living at home

(Ministry of social affairs and health 2012), while near to 8000 of them are living at home with regular

home care services (National institute for health and welfare 2011).

Cognitive disorders are the most significant predictor of long-term care among older people: 95% of long-

term institutional care clients and 60% of home care clients have some cognitive disorder. Other common

diseases among older people (75+ years) include diseases of the circulatory system, musculoskeletal

disorders and diseases, malignant tumours and diabetes. Projections of other disabilities show that the

number of older people with limited mobility will increase by 70% from 2000 to 2030 if the age-

groupspecific proportions stay the same as in the years between 1980 and 2000. (Turjamaa p 12-13)

10.1.1 Challenges of the Finnish home care

The professionals in the research of Turjemaa (2014: 44) reported that the focus of daily care was on

everyday activities was based on clients’ physical needs. They characterised the care as repeating similar

activities from day to day, home to home and client to client. Work was mechanical, performancebased and

standardized. The results of this study are similar to those indicated by previous studies, where task

orientation, illness-centred approach and being solely focused on clients’ physical resources have been

found to characterise professionals’ work with older people (Hayashi et al. 2011, Salguero et al. 2011). Both

clients and professionals saw meaningful and inspirational activities as the most important elements for

promoting clients’ living at home. (Turjamaa, 2014: 44.)

The current planning for older clients’ care is classification-based with an instrument-oriented approach

where there is a lack of acknowledgement of clients’ individual needs and resources. In addition,

classification-based documentation seems to be inflexible and hides the full picture of the client’s situation.

Current home care is organisationally-driven and the context of care is mainly routine-like help in everyday

activities, based on doing things on behalf of clients and ignoring their personal perspectives, individual

needs and resources. (Turjamaa 48)

By the results of Turjamaa (2014) showed elements that promote older clients living at home based on

clients’ individual skills and abilities as highlighted by home care services. One essential question concerns

the factors that contribute to older clients’ living at home. As populations are ageing, it is evident that

organisationally-driven and passive home care is causing increasing public health and financial concerns

(Hammar et al. 2008, National institute for health and welfare 2010). Additionally, because of their

availability, home care based on available services cannot respond to the challenges provided by care that

promotes clients’ living at home for as long as possible. Caring for clients in their own homes takes place in

a different context to hospitals and is one that requires a different approach.

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An interesting finding in the study of Turjamaa (2014) as well in Questionnaire for HHCP (2016, CARESS)

was that both older home care clients and home care professionals were very positive and interested in the

study and supported the development of home care when they had the possibility to tell their opinions

about the aspects of home care that should be developed. The professionals assessed realistically their own

working methods and the organization of home care services as a whole. Especially professionals

realistically assessed their current working methods as task-oriented, routine-like and based on a

philosophy of ‘doing on behalf of clients’ (Turjamaa 2014: 44).

With active and efficient rehabilitation and support of psycho-social functional ability is possible reduce the

need of home care and in some cases even clients won’t need homecare at all. In Finland in some areas

such kind of projects and interventions which have made good results and also reduced costs in public

homecare services.

10.1.2 References

Erkkilä, Sari: ’Asiakkaat ovat ihmisiä – eivät prosentteja’, Selvitys superilaisten työstä kotihoidossa ja

kotihoitotyön kehittämisestä. SuPer, Helsinki, 2015.

Salonen, Kari – Kinos, Sirppa (Eds.): Good Practices and Visions of the Future of Home Care Work in

Bulgaria, Finland, Greece and Turkey. Based on the EQUIP II (2010 – 2012). City of Turku, Education

Department and Turku Vocational Institute, 2012.

Taipale-Lehto, Ulla – Bergman, Timo: Competences and Skills Needs in Services for the Elderly. Publications

6, Finnish National Board of Education, Helsinki, 2015.

THL: 2014. http://www.julkari.fi/bitstream/handle/10024/126302/Tk05_2015.pdf?sequence=1. 11.4.2016.

Turjamaa, Riitta: Older People’s Individual Resources and Reality in Home Care. Publications of the

University of Eastern Finland, Kuopio, 2014.

10.2 Analysis of activities, skills and competences of home health care

practitioners in Finland

10.2.1 MATERIAL AND METHODS

Purpose of the study

The CARESS project will target the problem of skill mismatch in the field of elderly homecare by intervening

on a number of causes at national and European level. Purpose of this study was scarce definition of the

specific roles of each home health care practitioner (HHCP) and scarce definition of skills which should

characterize each HHCP.

Method

The questionnaire was developed by Caress –project. The questionnaire contains all together 67 items

including background questions, items regarding of activities home health care practitioners (HCCPs)

actually provides in elderly clients’ home and items of skills and competences of HCCP. The skills and

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competence levels are self-evaluated by HCCPs. The questionnaire contains also open end questions. The

questionnaire was translated in finnish and the questions were modified to taking in consideration of

finnish home care work environment. The questionnaire was sent as SurveyPal mode via e-mail to

members of Super (Finnish Union of Practical Nurses).

Sample

The questionnaire was send to (N= 2550) persons, whom are working in the homecare sector according to

Finnish Union Practical of Nurse (SuPer) membership registry and who have got at least the VET education

on EQF4 level. The response rate was 17 % (n= 433). Almost all of the responders (98,8 %) had more than

five years of work experience in older adult homecare. 27 % of responders had more than 20 years of work

experience over all. Majority were working in the public sector/municipalities (98,8 %). The respondents

were practical nurses (99,5 % ) in professional background and most of them were female (94,9 %) in the

age group between 36 – 50 years (36,5 % )(Table 30)

Variables n =%

Gender

Male Female

Age (years) <20 21-35 36-50 51-60 61-63 >63 Occupation

5,1 94,9 1,6 30,5 36,5 28,9 3,0 0,0

Practical nurse 99,5 Home helper Registered nurse Public health nurse Something else

Activity as practitioner Municipalities Public institutional homecare Private homecare provider Freelance professional activity Other (EKSOTE, OIVA etc.) Employment years <1 year 1-5 years 5-10 years 10-20 years >20 years

2,5 0,7 0,5 2,3 98,8 0,2 0,7 0,0 0,9 3,7 22,2 21,2 25,9 27,0

100% Table 30: Socio-demographic characteristics of the home health care practitioners (n=433)

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10.2.2 RESULTS

Time and regularity of the visits

The HHCPs spend average 15 – 30 minutes per visit at the older person’s home (72,7 %) and do visits 2 – 3

times in the week with the same client (42,5 %). 30,9 % of the clients needs 4 – 5 visits and (14,8 %) 6 – 7

visits and (14,5 %) more as 7 visits per week. Once a week visits are scheduled for (6,2 %) clients. (Figure

23)

In open end questions the respondents answered that the time lenght of visits are based on the clients’

needs. Some of the clients need visits lasting only few minutes to 15 minutes, while the others may need 45

to 90 minutes per visit. It was also mentioned that visits that last over two hours are rare, but possible. The

time spent with the client depends of the clients care needs, service plan, content of the visits (taking blood

samples, administering medications like injections, assisting in personal care such as helping with intimate

hygiene and eating) If the client have a shower day it takes usually approximately an one hour.

The fact of the amount of the clients to visit per shift also have effect on how much time home care

professionals have to spend in each client. Nurses shifts (ie morning or evening shift) effects to some extent

as some of the respondents mentioned that during the weekday there is much more time to spend than on

a weekend or in the evening shift, when the visiting time at client’s home is from ten minutes to an half

hour. The phone calls to clients takes about five minutes of working time.

Figure 23: The average amount of the visits with same client per week (Once 6,2 %, 2-3 times 42,5 %, 4-5 time 30,9 %, 6-7 time 14,8 %, more than 7 14,5 %)

Activities carried out in elderly clients home

According to the results the most common activities the home health care practitioners carry out

in older person home are assistance in activities of daily living (99,3 %) (Table 2) and supporting

6,2 %

42,5 %

30,9 %

14,8 %

14,5 %

0,0 % 20,0 % 40,0 % 60,0 % 80,0 % 100,0 %

once

2-3 t imes

4-5 t imes

6-7 t imes

More

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clients to perform these activities independently. Assistance in activities of daily living include

assistance in personal hygiene, dressing, eating and drinking and assistance in toilet. (Table 2).

The vast majority of HCCPs did administering and assessing medications to the clients (99, 3 %)

(Table2). This included administering different types of medications (eye drops, nose drops,

injections e.g klexane, insulin) and dispensing oral medicines into pill dispensers.

HCCPs (93, 9%) evaluated clients health condition during the visits and (86, 6 %) of them gave

guidance and education in health management and lifestyle. According to the answers to the

questionnaire (Table 2) and the open end question answers the clinical nursing procedures that

HHCP`s carried out in home care were taking measurements (blood pressure, blood sugar and

weight), taking samples for lab tests (e.g. INR, CCMSU), taking care of nutrition via peg-feeding,

exchanging stoma and ostomy bags, putting on compression stockings (96, 5 %), wound care (92,6

%) (e.g assisting in NPWT= negative pressure wound therapy, assisting and skin care with cystofix

catheter, nefrostomy and tracheostomy), biliary drainage care, removing stitches. The

respondents mentioned also helping the clients with oral health, providing psychological support,

terminal care and running the clients’ errands (e.g walking the dog).

In rehabilitation the HHCPs were involved mostly by doing walking exercises with the clients (71, 1

%) and the least regularly (31, 5 %) in doing memory exercises with the clients (Table 2). They also

helped the clients to implement the contracts made by physiotherapist to exercise in home. This

included assisting, supporting and guiding the clients to do exercises in home environment (e.g

chair exercise, exercise with weights or rubber bands) for gaining the muscle strength and balance

training. HHCPs also help clients with the use of different aid and ancillaries.

In open end questions results was found out that the HHCPs were also using as a method of

rehabilitation to support client`s self-management skills in everyday life (rehabilitative shopping,

help with clients` everyday activities) In respondents opinion they didn`t have enough time to do

the memory tests or take clients for a walk during the day. The respondents were concerned of

the fact that when the HHCPs have a limited time, the work can easily slip into helping the clients

too much, without assessing clients ‘abilities to do their own care independently and encouraging

them to do more by themselves. Also the psychosocial support needs to be take into

consideration. (82, 5 %) of HCCPs were taking care of safety at the clients home (Table 2).

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Cooperation with the clients’ relatives was mostly advising of relatives (92 %) The HCCPs also

worked in with the multi-disciplinary teams (74%) Reporting of the activities was done by 90, 2 %

of the responders

%

Clinical activities related to assessment and planning evaluation of customer needs evaluation of health condition RAI measurements in-home health exams personal assistance planning

60,0 93,9 26,5 34,3 41,6

Social/Environment/Education companionship, support and assistance in social relationships intervention for a proper prescription and use of principals devices in home environment guidance and education in health management and lifestyle.

Information about different social services Support and assistant in different things

67,2

50,0 86,6 51,9 44,0

Support to independence Assistance in personal hygiene (bathing, grooming, etc.) Assistance in dressing house management and cooking positioning and supporting mobility Assistance in toilet Assistance in proper maintenance of the house including cleaning and order washing, ironing and organization of the clothes inside the home

Taking care of safety at home

99,3 97,7 95,3 89,5 97,4 77,9

82,8

Clinical activity related to therapy pharmacological treatment and homeostasis maintenance, performance relating to excretory functions Wound care Stoma care Need of technical support with external devices: catheterization Putting aid dressings or compression stockings Skin treatment and care Something else

99,3

92,6 58,4 70,7 96,5 97,0 12,1

Rehabilitation approach Walking exercises Memory exercises Position of the treatment Supporting to independency and ability to function Something else

71,7 31,5

43,6 95,5 10,7

The skills and competences HCCPs need in home care

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In the questions regarding skills and competences needed in home care the responders were

asked whether they need this skill and competence in their work and in which level their skills and

competences were in their own opinion. They were also asked where have they gained the skills

and competences (education or in work).

The results showed that according to the HCCPs they need for example general knowledge, skills

and competence in medical knowledge specifically related to the profession (85, 5 %) and (58, 9 %)

thought this skill and competence was in good level. They had gained this in both education (59,8

%) and in work (60,5 %). (Table 31). All the answers regarding different skills and competences, skill

levels and where gained (percentage of answers) are shown in (Table 31).. List of detailed

percentanges of answers see (Appendix 3).

In general responders evaluated that they need lots of basic theory knowledge (mostly over 70 %)

of various subjects (Table 3) to be competent professionals. They didnt find that they need skills of

cooking (39,0 %) or skills of using ICT for social participation (40,1 %) as such much. Also

competence in procedures for providing physical therapies (41,1 %) was not so highly regarded by

responders. In most of the items of questionnaire the responders evaluated that their competence

was on average or high level. (Table 31).

Competencies for terminal illness support (31,3 %) and grief support (25,2%) of the responders

evaluated themselves on low level. Competences for evaluating customer mental health status

was also quite low (21,6%) of evaluated this on low mastery level. Knowledge of services and

social benefits was also found on satisfactory level by (20,2%) of respondents. Highest

competence level was on competence in assisting on personal hygiene (65,6 %) of responders

evaluated themselves on high level. Competences for collaborating with other practitioners the

HCCPs (81,6 %) have gained mostly by working and competence in basics in anatomy and

pathology (79,9 % of responders) have gained mostly by attending a school, training course or

academic course. Also basic procedures in medical assistance (eg. make injection, provide drugs,

change medications, etc. were primarly gained in school or in training (75,1 %).

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COMPETENCE IS THE

COMPETENCE

REQUIRED?

SELF-EVALUATE

THE LEVEL YOU

MASTER THE

COMPETENCE

COMPETENCE

ACQUIRED

ATTENDING A

SCHOOL, A

TRAINING

COURSE OR AN

ACADEMIC

COURSE

COMPETENCE

ACQUIRED BY

WORKING

PRACTICE

YES answers Low Mastery

Average Mastery

High Mastery]

YES YES


85,5 % 3,3 %

58,9 %

34,3

59,3 % 60,5 %


80,6 % 16,1 %

61,4 %

17,3 %

79,9 % 37,1 %


82,1 % 0,2 %

32,6 %

61,2 %

53,5 % 65,6 %


65,8 % 5,2 %

36,5 %

48,5 %

34,4 % 71,7 %

Basics in dietetic 78,6 % 3,7 %

51,5 %

39,6 %

72,5 % 45,9 %


75,5 % 2,8 %

51,6 %

39,3 %

63,3 % 52,8 %


60,8 % 22,4 %

50,1 %

16.8 %

70,2 % 39,2 %


76,3 % 5,6 %

57,0 %

30,7 %

48,1 % 66,5 %


73,5 % 30,0 %

52,9 %

10,5 %

36,8 % 72,4 %


78,3 % 8,9 %

56,5 %

27,8 %

29,7 % 79,9 %


44,7 % 24,0 %

50,6 %

8,8 %

28,5 % 58,9 %


71,4 % 27,6 %

52,2 %

11,5 %

70,5 % 35,1 %


84,4 % 3,3 %

42,0 %

49,0 %

75,1 % 54,3 %

Other specific basic medical procedures

78,3 % 9,2 %

57,5 %

51,7 % 69,8 %

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related to my profession 25,5 %


84,6 % 3,0 %

39,9 %

53,1 %

74,6 % 54,3 %


41,1 % 29,2 %

44,4 %

6,5 %

41,4 % 53,0 %


57,3 % 10,1 %

58,0 %

19,2 %

40,6 % 58,0 %


78,5 % 0,5 %

28,8 %

65,6 %

55,5 % 59,0 %


78,6 % 2,1 %

53,4 %

39,2 %

48,3 % 69,7 %

Cooking 39,0 % 4,2 %

35,7 %

41,1 %

32,9 % 55,8 %


60,1 % 8,9 %

49,9 %

29,8 %

52,9 % 50,6 %


69,0 % 5,9 %

54,9 %

29,8 %

50,0 % 59,4 %

Managing errands


82,9 % 5,6 %

51,8 %

36,8 %

34,7 % 77,3 %


61,6 % 14,4 %

53,9 %

18,4 %

24,2 % 75,5 %


57,3 % 19,3 %

54,7 %

9,4 %

22,2 % 71,7 %


40,1 % 17,5 %

39,2 %

17,5 %

25,7 % 58,0 %


79,5 % 10,6 %

51,2 %

29,7 %

33,7 % 75,0 %


74,8 % 20,2 %

56,0 %

15,8 %

27,1 % 79,5 %


85,1 % 2,8 %

50,0 %

41,2 %

69,2 % 50,2 %


80,0 % 3,6 %

41,0 %

49,8 %

49,0 % 69,0 %


67,2 % 14,6 %

55,7 %

24,1 % 75,5 %

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19,3 %


79,5 % 6,1 %

56,8 %

30,4 %

27,4 % 81,6 %


52,8 % 24,8 %

45,8 %

7,5 %

22,4 % 61,4 %


69,0 % 17,5 %

44,1 %

22,0 %

18,2 % 72,3 %


81,2 % 8,9 %

55,3 %

28,7 %

29,9 % 80,7 %


75,8 % 21,6 %

52,2 %

17,6 %

43,5 % 71,1 %


71,2 % 9,0 %

61,0 %

18,3 %

26,0 % 75,0 %

Grief support 66,8 % 25,2 %

46,1 %

16,5 %

36,2 % 66,8 %


65,2 % 31,3 %

37,9 %

12,9 %

48,0 % 56,5 %


81,9 % 4,2 %

51,4 %

38,0 %

39,2 % 78,4 %

Table 31: Competences needed in home care (percentages of given answers)

Assessing the older persons needs

According to the results (74, 8 %) of HCCPs of this study did not normally participate in the first definition of

the older person’s care needs and (66, 7 %) didn’t formalize in the sheet, a chart or a report the initial

evaluation of older person’s needs. However (68, 6 %) of responders participated in the definition of a

personalized homecare plan of the clients as their care process continued and evaluated (90, 3 %) in elderly

needs in order to possibly refine the homecare plan according to changing situations. The (93, 3 %) of

HCCPs reported the clients implement care. The responders (87, 5 %) thought that they have the proper

competencies to evaluate older person’s needs and build a personalized homecare plan.

In open end questions answers the responders (13, 9 %) who didn’t evaluate to have enough competence

to build a personalized homecare plan brought out that they don’t have enough time to learn necessary IT

programs actualize the care plan to patient files. They also didn’t have enough time to do all the paper

work as they have too many care visits to do per shift with aging clients with cognitive and psychological

disabilities. Because of the limited time, HHCPs thought it was hard to get to know the client and to have

the clients’ trust and to take care of them holistically. ”It is hard to do the assessment when you haven`t

even met the client” one respondent answered. That is also effecting for the quality of the care.

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Some of the respondents didn’t know, how to make and document the care and service plan for the home

care clients, because usually the registered nurse or public health nurse are responsible for the planning,

taking care and evaluating the care and service plan. The form of documentation of the care and service

plans also vary. One respondent was saying that they don`t have clear form for the care and service plan.

Methods to do the care and service plan also varied depending municipalities. In one respondent’s opinion,

she would have the skills to do the care and service plan, if she only had the authorization.

According to some of the respondents, doing night shifts, having a part-time job, being a student were all

influencing the fact that they didn`t have skills for doing and assessing care and service plan. Some

disclosed that they don`t have proper introductions for doing assessing and care and service plans.

In general respondents answered that they need more education and experience for assessing the care

planning. Some of the HHCPs that answered that they didn’t have skills to do the care and service plan to

the clients, were also mentioned, that they didn`t have the knowledge enough to do the care and service

plan. In their opinion, they didn`t have enough the knowledge how to get the background information;

assess the clients` demographic history, health status (including functional and cognitive status), living

conditions and recognizing the social relationships. This is the result from rarely visits to the client as well as

the lack of time.

10.2.3 DISCUSSION

Home health care practitioners carried out mostly the following activities at clients home: assistance in

activities of daily living, evaluating clients health condition, various clinical nursing procedures and

administration and assessing medications. In Finland practical nurses are authorized to dispense and

administrate medication by oral route after qualification from formal education and gaining authorization

by passing exams in their work place. (Act on Health Care Professionals, 28 June 1994/559, National

Supervisory Authority for Welfare and Health 2016). HCCPs also supported clients’ rehabilitation by

different methods and worked in multi-disciplinary teams and took care of safety at clients home.

The results indicated that the activities HHCPs carried out were in line with the national legislation of home

care services in Finland. According to the laws, the national government has a supervisory role mainly by

law and information steering systems. Different laws are related to home care and its organizational and

financial structures. The important law; Social Welfare Act requires the services that municipalities must

produce and it includes the home help services. The act on supporting the functional capacity of the older

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population and on social and health care services for older people (980/2012) defines that every client who

regularly receives home care services has a right to have an individual care and service plan. Laws on health

care, primary health care and specialized medical care cover health services. There are also few separate

laws on occupational health care, mental health services and the prevention and treatment of infectious

diseases, and the status and rights of patients which includes the right to participate in the care planning.

Act on care services for the elderly ensures that elderly people will receive care and treatment according to

their individual needs. The act also specifies the responsibilities of local authorities and must be drawn up

without unnecessary delay once the older person`s service needs have been investigated (Ministry of Social

Affairs and Health 2012; 2016, Genet, Boerma & Rissanen 2010). Home care services consist of domestic

help including personal and physical care such as meals on wheels, bathing, electronic alarm service (Social

welfare act 1301/2014) and care based on nursing such as taking care of medication and wound care

(Public health act 1326/2010).

The results indicated that majority of responders thought that almost all the competences included in

questionnaire used in this study are required in working in home health care. In self –evaluation of HCCPs

skills and competences level, the responders evaluated their competence level satisfactory in knowledge of

social- and health service system inc. social services and benefits client is entitled to Knowledges, skills and

competences were also evaluated mostly in categories of satisfactory or good in procedures for providing

physical therapies, fostering clients social and familiar relations, competences to support for coordinating

the work of other practitioners, competences for evaluating clients mental health status and competences

for caring clients with terminal illness and grief support.

Presumably HCCPs self-evaluated low competence level in hospice care (i.e. terminal care) and supporting

grieving process was due that in Finland home health care service is not usually involved in hospice care

and care of dying at home. According to Social Affairs and Health Ministry in Finland statistics year 2008

only 10 % of over 75- year old persons died at home (Pihlainen 2010). Still most of the Finnish people would

like to die at home. (hyväkuolema.fi 2016). One of the obstacles for hospice care at home or reason for

discontinue it at home were that relatives caring for the dying patient weren’t coping mentally or

physically. (Pihlainen 2010). It was also found out that in practical nurses’ basic education didn’t contain

enough lessons of hospice care (i.e only couple of hours) (Pihlainen 2010). In spring 2009 a discussion was

conducted at the Ministry of Social Affairs and Health in Finland on the need to develop hospice care in

Finland and recommendations for hospice care were made. The recommendations emphasize the human

dignity and right of self-determination of the dying individual. A good hospice care requires competence of

the care staff and maintenance of their wellbeing at work. Hospice care is to be organized according to the

patient’s wish either in the patient’s home or in an institution. Specialization training in hospice care for

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nurses and practical nurses should be started as soon as possible according to this recommendations.

(Pihlainen 2010).

Even the curricula of Practical nurses Vocational Qualification in Social and Health Care (2010) includes the

basic nursing of patients mental health and drug abuse diseases and promoting the client or patient’s

physical and mental health, security and wellbeing. (National Board of Education 2010). It seems that skills

and competences in this area are not sufficient enough. Maybe the focus of the home care work is also

based on physical care needs and clients clinical condition than the mental status. (Turjamaa 2014).

HCCPs had acquired competence mostly by working practice in following skills: basics in social-health

services organizations and networks, knowledge about the main aids and devices for older and disabled

people, procedures for fostering customers going out of home, providing the customer with contextualized

and personalized information about the network of social services and benefits he/she can rely on,

competences for collaboration with other practitioners and competences for evaluating customer needs

and adapting the service. Competences in basics in anatomy and pathology, basic procedures in medical

assistance (eg. make injection, provide drugs, change medication) HCCPs have gained mostly by attending a

school, training course or academic course.

HCCP didn’t take a part of the first evaluation and forming a clients’ care and service plan. This is probably

the reason why they evaluated their knowledge of social services and benefits lower than expected.

However HCCPs were involved in modifying and assessing clients care plans in continued care. Yet they

thought that they could have competences to do it, if given time, education and authorization. It seems

that in division of tasks in home care doing the care plans especially on beginning of the care of the new

client is done by the registered nurses or registered public health nurses.

In Finland a Vocational Qualification in Social and Health Care (practical nurse education) include education

of planning and implementing care plans. The practical nurse education may also include Home care and

nursing of the elderly as an elective module through the student’s personal study plan. Then a student

must have passed at least Nursing and Care (30 competence points) in a skills demonstration test, prior to

embarking on this elective module. In vocational upper secondary education, the module gives 15

competence points. If student chooses The care for the elderly as competence area the curricula contains

the skill requirement of ability to plan, implement and assess the care of and service to the elderly, take

their resources and participation into account. (Finnish national board of education 2010).

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In conclusion to be made of the results are tentative due methodological weaknesses such as the reliability

of the questionnaire can be compromised. The future education needs for the Home health care

practitioners are hospice care, evaluating clients mental health, knowledge of social services and benefits

and planning and implementing care and service plans.

10.2.4 References

Act on Health Care Professionals, 28 June 1994/559 (Laki terveydenhuollon ammattihenkilöistä,

28.6.1994/559). Visited on 17th May 2016. http://www.finlex.fi/fi/laki/ajantasa/1994/19940559

Genet N, Boerma W & Rissanen S. 2010. Finland p.86-98. In Genet N, Boerma W, Kroneman M, Hutchinson

A & Saltman RB. Home care across Europe. Case studies.

http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf (Visited on

16th May).

Finnish national board of education 2010. REQUIREMENTS FOR VOCATIONAL

QUALIFICATIONS Vocational Qualification in Social and Health Care

Ministry of Social Affairs and Health. 2016. Legislation: http://stm.fi/en/social-and-health-

services/legislation

Ministry of Social Affairs and Health 8.11.2012. Vanhuspalvelulailla turvataan laadukkaita palveluita

iäkkäille koko maassa [visited 16th May] Act on care services for the elderly to ensure high standard of

quality nationwide, http://stm.fi/en/article/-/asset_publisher/alderslagen-tryggar-hogklassig-service-for-

aldre-i-hela-landet

Professional practice rights. National Supervisory Authority for Welfare and Health (Valvira)

http://www.valvira.fi/web/en/healthcare/professional_practice_rights

Pihlainen. A (2010). Terminal care recommendations based on expert consulting. Ministry of social affairs

and health in Finland.

Ten questions of dying. Hyvä Kuolema.fi http://www.hyväkuolema.fi/category/kyselyt/

Turjamaa, R. 2014. Older people’s individual resources and reality in home care. University of Eastern

Finland, Faculty of Health Sciences Publications of the University of Eastern Finland. Dissertations in Health

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Sciences 255. . [Cited 2016 April 10]. Available from http://epublications.uef.fi/pub/urn_isbn_978-952-61-

1616-7/urn_isbn_978-952-61-1616-7.pdf

10.3 Home care clients’ perceptions of quality of care and staff

competence

Objectives: To know the actual activities carried out at the elderly home by Home Health Care Providers

(HHCP) and to know the needs perceived by the elderly, their priority and which of them are fulfilled by the

service in their view. This study also aimed to know elderlies opinion about further activities that should be

performed or activities that should be improved and to know the elderly satisfaction level

Sample and methods: Nine elderly home care clients, aged between 80 and 97, answered semi-structured

questionnaires

Results: The activities that HHCP normally carried out in the elderly`s home were categorized in eight

categories: Health promoting activities, Administration and assessing medications, Assistance in activities of

daily living (IADL), Clinical nursing interventions, Domestic help, Assistance in application of social

allowances and benefits, Rehabilitation activities and Support and assistance in social relationships. In this

study activities were mostly focused on nursing procedures and administering and assessing medications

which was also mentioned to be the most important priority care need to the clients in their own opinion.

Despite the importance of this care need, clients assessed the HHCPs competence level only satisfactory or

even poor. All in all the clients (78%) thought, they had received help needed. Clients` opinion about

further activities that should be performed, the clients indicated that they would like to have more time for

discussion (33%), walking tours (22%) and shopping (11%) with the HHCPs.

Conclusions: The results show that in the future, HHCPs education needs has to be considered in the

categories of administration and assessing medications and ethical skills. Also interaction skills as well as

the HHCPs ability to plan the care needs individually and giving enough time for the client, are important

aspects. HHCPs spent on average from 30 minutes to one hour in client`s home, which in some way may

reflect the clients` need of the discussions with HHCP`s. Furthermore the stability of the staff should also be

considered.

10.3.1 Purpose of the study

Demographic ageing is one of the most serious challenges Europe is facing. Better care and sustainability of

health services calls for innovative ways to address the needs of the elderly. Supporting homecare, i.e. care

provided by professionals within users’ own homes, has been identified by EC as a possible solution.

Although a high number of elderly and their families are searching for skilled practitioners they often have

to face a mismatch between the skills they are asking for and those offered by job-seekers. The CARESS

project will target this skill mismatch in order to overcome it. The project will pursue the following

objectives at national and European level:

a) definition of the specific roles of each HHCP

b) definition of skills which should characterize each HHCP

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c) definition of VET pathways/curricula that HHCPs should attend to get skilled in elderly homecare; d.

definition of HHCP career pathways

d) recognition of qualifications and consequent enhancing of labour mobility;

e) Integration of the above defined information about HHCP in national/local occupational profiles

and VET curricula.

The above mentioned objectives will be pursued through a number of activities including gathering

background data by interviews and semi-structured questionnaires by the end-users as elderly home care

clients. In Finland semi-structured interviews of the elderly home care clients were carried out by project

members in Omnia. The interview form was made by CARESS –project and it was translated in Finnish.

The aim of this study was 1. to know the actual activities carried out at the elderly home by HHCPs, 2. to

know the needs perceived by the elderly, their priority and which of them are fulfilled by the service in

his/her view, 3. to know elderly opinion about further activities that should be performed or activities that

should be modified/improved, 4. to know the elderly satisfaction level

10.3.2 Material and methods

Sample

Nine elderly homecare clients participated in this study. Eight of the participants were woman and one

man. The mean age was 87,7 years, the youngest was 80 and the oldest 97 years old. Participants lived

mostly in town centre (n=6), Three lived in rural area (table 1).

Variables n = 9 (%)

Gender

Male Female

Age 80-84 85-89 90-94 95-99 Living environment

1 (11,1) 8 (88,9) 2 (22,2) 4 (44,4) 2 (22,2) 1 (11,1)

city 6 (66,7) rural 3 (33,3)

Table 32: Socio-demographic characteristics of the home care clients (n = 9)

Data collection

Open semi-structured interviews were made with nine 80-97-year-old elderly home care clients in their

own home. The youngest was 80 years and the oldest 97 years old. Among the clients, there was one

married couple. Most of the interviews were collected by interviewer present face to face in the

interviewees own homes and one was done via phone. Interviews were done in February-March 2016.

Participants were known to interviewers beforehand by relations or other ways. Home Health Care

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Practitioner was present in two of the interviews. The interviews were structured by questionnaire made

especially for this purpose in Caress project.

Data analysis

The interviews were analyzed using qualitative content analysis. At first the answers of the interviews were

read to get first impression of the content. Then the text was categorized in the meaning-units

corresponding to the aim.

10.3.3 Results

TIME SPENT WITH THE CLIENT

HHCPs service time recipients at home was on average from 30 minutes to one hour (44%). It also varied

from 15 minutes (22%) to 30 minutes (33%), but nobody had the caregiver at their home for more than 1

hour. Clients received on average the visit of caregiver in their home more than 7 times per week (56%).

One client was visited once a week and one client received a visit from 5 to 7 times per week. One couple

was visited once in every other week.

ACTIVITIES CARRIED OUT ELDERLY HOME BY HHCPS

Activities carried out in elderly`s home by HHCPs were divided in eight categories: Health promoting

activities, Administration and assessing medications, Assistance in activities of daily living (IADL), Clinical

nursing interventions, Domestic help, Assistance in application of social allowances and benefits,

Rehabilitation activities, Support and assistance in social relationships. The results of the interviews showed

that the activities that HHCP normally carried out in the elderly`s home were more focused on nursing

procedures like assistance in activities of daily living (IADL) (n=5) and administering and assessing

medications (n= 9).

Health promoting activities included assessing clients care needs, assessment of functional capacity, health

education of clients and their relatives, disease prevention, assuring home security and safety phone. 33%

of the clients had assessment of the care needs and 56% had evaluation of their health condition. Personal

assistance planning was provided for 22% of the clients. HHCP was monitoring healthy lifestyle and

preventing illness according to 44% of the interviewed clients. Home Environment assessment in terms of

safety for example testing the safety phone, fire alarm and assisting in technical aids such as rollator,

wheelchair were assisted by six (67%) of the clients. Education in health management and lifestyle was

provided in 33% of the clients.

Administration and assessing medications included assessing, planning, implementing and evaluating

medical drug therapies as well as educating clients about their medical drug regimens. Administering and

assessing medications was normally carried out in every client`s home by HHCP. This included for example

taking care of client`s diabetic medication, dispense medicines and monitoring the impacts of medicines.

44% of the clients had assistance in the prescription.

Assistance in activities of daily living (IADL): Activities of daily living included personal hygiene (bathing,

grooming and oral care), clothing (the ability to make appropriate clothing decisions and physically dress

oneself), eating (the ability to feed oneself though not necessarily to prepare meals), maintaining

continence - both the mental and physical ability to use a toilet, mobility at home (moving oneself from

seated to standing and get in and out of bed). The clients were mostly assisted in daily living (ADL), such as

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personal hygiene (56%), toilet use (33%) and assistance with feeding (33%). HHCP also assisted clients` in

clothing (22%) and transferring (11 %) although it was not so common. Assisting clients with mobility at

home such as positioning and supporting mobility’s or doing some rehabilitation activities were carried out

by HHCP in 33 % clients. In addition some of the clients (33%) got support to daily activities (shopping,

going to a medical appointment, etc.).

The HHCPs provided also Clinical nursing interventions such as wound management (22%) and chronic

wound management after surgery (11%), monitoring clients respiratory, blood pressure (89%) taking blood

samples (22%), applying compressive stockings (11%), stoma care (11%).

Domestic help offers daily housekeeping services (including laundry) and preparing meals. Assistance in

cleaning the home was provided for some (44%) of the clients (for example cleaning a toilet, dusting,

changing sheets, washing dishes, taking out the garbage).

Assistance in application of social allowances and benefits. This includes giving information to clients of

home care allowances and requirements for these allowances and also helping clients filling out the forms.

This category was carried out with 44% of the clients.

Rehabilitation activities includes assistance of ancillary tools and supporting clients’ rehabilitation.

Supporting mobility or doing some rehabilitation activities were carried out by HHCP in 33 % of the clients.

44% clients had assistance in the use of principals’ tools in home environment (crutches, wheelchair, blood

pressure measurement machine, etc.).

Support and assistance in social relationships: Interviews showed that assisting, guiding and encouraging

clients to take part of social activities for example day care centers were familiar to. 56% of the clients had

support and assistance in social relationships Companionship such as giving psycho-social support and

discussion with clients were not provided by HHCP. One client had support every day with opening

television and radio or getting the newspaper.

CARE NEEDS AND PRIORITY OF THE CARE NEEDS

The clients were asked about, whether the care needs were met by the home care service. Seven of the

nine clients, who participated the study applied `yes` to this question. One applied `no` and one didn`t

answer the question. In conclusion 78% of the clients had their need fulfilled. The most important care

need the clients brought up as a priority was administering and assessing medication (67%). Other

important needs were blood samples taking by Home Care, to be helped in getting out of the house, clinical

nursing interventions including taking blood pressure, stoma care, wound care, assisting in daily living

(hygiene, incontinence care, nutrition, rehabilitation), taking care of psychological wellbeing.

When asked about further needs, the clients indicated that they would like to have more time for

discussion (33%), walking tours (22%) and shopping (11%). Some actions do avoid the loneliness or social

isolation. One of the clients answered that is not getting enough services from public health care, and

therefore buying some services from private sector. The clients also hoped for the stability of the staff so

that the same HHCPs would take care of them as to provide continuous care relationship.

COMPETENCE AND SKILLS OF THE PRACTICAL NURSES

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In general the clients were satisfied for the services Home care provided. They were using expressions like

`excellent` and `good` and ratings were from six to ten in the scale of one to ten (table 2). Interaction

between the client and HHCP were described as friendly or close (67%) and interaction was also mentioned

to be professional (56%). The HHCPs were described to be very polite and treating the clients respectfully

as always asking clients opinion. However it was mentioned that interaction varied a lot between different

HHCPs. Otherwise two of the clients described interaction very distant or lacking and criticized that the

HHCPs who provided the care are constantly changed. Some of the clients had some bad experiences that

nurses were very busy, intimidating and even have been working under the influence of the alcohol.

Table 33: Clients` opinions of the home care services

The clients were asked to mention to consider abilities that should be fundamental for a homecare worker

to have. To ability to listen the client, to be emphatic, friendly, calm, determined, reliable, to have sense of

humor. Professional skills were also mentioned, for example competence in drug therapy. Domestic skills as

ability prepare meals and making coffee. Ability to assess the clients’ heath condition in hole.

A worrying result was that administrating and assessing medications skills were satisfactory or even poor.

One married couple answered, that the medication skills were good, but on the other hand, they meant

registered nurses as well. Clinical nursing skills were said to be good as skills assisting activities in daily living

although there was variation in skill level depending on the HHCP. Clinical nursing skills were said to be

good as skills assisting activities in daily living although there was variation in skill level depending on the

HHCP. The clients’ perceptions of the ethical competencies were mostly satisfactory level or it was varying.

It was mentioned that knowledge was mostly excellent but it was also varying between HHCPs. Although

the clients were using domestic care services, none of them mentioned it when asked about competence

and skills of HHCPs.

The clients were asked to mention three things that HHCP provides that improve the quality of their life

and helps them in managing in their own home. There were helping activities in daily living (hygiene,

nutrition), medication (56%), measurements (blood pressure), clinical nursing activities (stoma care),

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

General satisfaction with home care services

Interaction between HHCP

Important assistance needs are taken into accountprimarily

Feeling of being helped

HHCP recognizes the needs for help and services

Clients` opinions of the home care services

Totally disagree Disagree Uncertain Agree Totally agree

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support client`s in performing their errands (e.g. pharmacy, shopping), rehabilitation, maintain the social

relationship for example helping to visit the spouse in nursing home or taking part of social activities.

10.3.4 Discussion

According to these interviews HHCPs carried out mostly following activities in elderly clients’ home: Health

promoting activities, Administration and assessing medications, Assistance in activities of daily living (IADL),

Clinical nursing interventions, Domestic help, Assistance in application of social allowances and benefits,

Rehabilitation activities and Support and assistance in social relationships. These activities are in line of

services that are provided by public health services normally. Finnish municipalities have a statutory

obligation to provide and arrange health and social services which includes homecare services (Paljärvi et al

2011). In Finland the Social Welfare Decree (607/1983), §9, the way that home-help services are organized

is defined: 1) assistance, personal attendance and support provided at home by a trained home helper for

house aid for an individual or a family and 2) auxiliary services (meals on wheels, maintenance of clothes,

bathing, cleaning, transportation and services promoting social interaction. (AlzheimerEurope)

For example the Department of Social Services and Health Care of Helsinki City Home care services support

customers living at home in the daily functions that they cannot manage by themselves. Such functions

include eating, bathing, dressing, getting up from the bed or a chair, walking and toilet visits. Home care

customers can also receive health care and medical treatment in their homes if these services cannot be

reasonably organized in any other way (City of Helsinki). In Paljärvi study (2012) was also found that

activities home health care mostly provided were, administering and assessing medications, clinical nursing

interventions and discussions with clients.

The results of the interviews showed, that administering and assessing medications was one of the

activities that HHCPs routinely carried out in the elderly clients´ home. Administration and assessing

medications was also brought up as the most important priority care need to the clients in their own

opinion. Concerning result was that, in this activity clients assessed the HHCPs competence level only

satisfactory or even poor. Weak interaction skills and ethical skills as some HCCPs appearing intimidating

and not listening elderly clients’ needs and wishes was also a result that should be taken into consideration

in health care organizations and education. According to Salermo`s study (2011) of practical nurses` (n=200)

pharmacological skills, the results showed that the greatest skill deficiencies in pharmacotherapy were

related to basic knowledge about medication, and drug interactions and adverse drug reactions. The

findings of Turjamaa (2014) study showed that clients and professionals described medication as one of the

most major things to take into consideration in care planning. This emphasis was also visible in care and

service plans. Nevertheless, especially from the perspective of professionals, taking care of medication was

mechanical and instrumentally orientated in terms of administration of drugs instead of monitoring the

effectiveness or adverse effects, which were noted only in three care and service plans.

Interviews showed that time spent with the client was on average from 15 minutes (22%) to one hour at

the most. According to clients, some nurses were very busy and the clients wished for more time spent

with them; to have a dialog, discuss and take walks. According to Paljärvi et all (2011) studies, results are in

line with other Finnish studies that have explored the impact of integration on homecare quality and

identified that nurses are too busy and have lack of time for the client. In this study clients also wished for

caregivers’ stability, so that the same HHCPs would be taking care of them continuously. In Paljärvi (2012)

follow-up study continuity of the home care declined and only 35 % clients responded that they have had

same home health care provider visiting them in last six months and only 16 % assessed that home health

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care providers are not in hurry. Also in Turjamaa (2014) study, the interviewed clients found that the first

step needed to take in order to promote their living at home is having the same nurse care for them

continuously. The clients described that having the same personal nurse makes it possible for them to

create a familiar and confidential relationship with them. Based on professionals’ opinions, a personal

relationship makes it possible to take into account individual resources and habits of the clients.

However, when asked in general the clients in this study were satisfied for the services Home care

provided. They were using expressions like ”excellent” and ”good” and ratings were from six to ten in the

scale of one to ten (table 2). Also in Paljärvi (2012) follow-up study participants, home care clients (n = 66 -

84) and relatives (n = 73 -7 8) were quite or very satisfied of home care received.

There was much variation in quality of the care depending on HCCP. Interaction skills, professional skills

and competence were described by clients verbally in scale very poor, lacking to excellent. In Turjanmaa

(2014) from home care clients’ perspectives, routine-like activities of daily living revealed predominantly

hasty and restless behavior of practical nurses. It is concerning that home health service is not able to

provide constant level of care. It would be important to be able identify HCCPs, who need further education

and training to quarantine good level of care every day to all the clients.

In this rather small study with compromised methodology the results showed that, in Finland the HCCPs

education needs seemed to be in categories of administration and assessing medications and ethical skills.

In Turjanmaa`s study (2014) summary of results indicated that living at home for as long as possible also

requires a care relationship that is founded on reciprocity and a safe care context.

10.3.5 References

AlzheimerEurope. Country comparsions of Home Care Finland.http://www.alzheimer-europe.org/Policy-in-

Practice2/Country-comparisons/Home-care/Finland. Visited 10.4.2016

City of Helsinki. Social services and health care. Elderly services. Home care –Internet pages.

http://www.hel.fi/www/Helsinki/en/socia-health/elderly/home/ Visited 8.4.2015

Paljärvi Soili. 2012. Homecare in change, A 15-year follow-up study in the organisation, content and quality

of homecare in the City of Kuopio. Doctoral thesis. Universtíty of Eastern Finland

Paljärvi S, Rissanen S, Sinkkonen S, Paljärvi L. What happens to quality in integrated homecare? A 15-year

follow-up study. International Journal of Integrated Care. 2011 June 15; 11. [Cited 2016 April 8]. Available

from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178800/

Turjamaa, R. 2014. Older people’s individual resources and reality in home care. University of Eastern

Finland, Faculty of Health Sciences Publications of the University of Eastern Finland. Dissertations in Health

Sciences 255. . [Cited 2016 April 10]. Available from http://epublications.uef.fi/pub/urn_isbn_978-952-61-

1616-7/urn_isbn_978-952-61-1616-7.pdf

Salermo E. Primary nurses` knowledge of geriatric pharmacotherapy. 2011. Master`s thesis in gerontology

and public health. University of Jyväskylä. [Cited 2016 April 8] Available from

https://jyx.jyu.fi/dspace/bitstream/handle/123456789/27151/URN:NBN:fi:jyu-

2011061310989.pdf?sequence=1 )

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10.4 HHCP involved in older persons homecare service in Finland: roles and competences

Occupation ROLE: content of

the work/sets of

activities

theoretical and/or factual

KNOWLEDGE

SKILLS as cognitive and practical COMPETENCE

HHCP1 PRACTICAL NURSE

Home-help services mean performance of or assistance with functions and activities related to housing, personal care and attendance, and other conventional functions and activities in normal daily life.”

Legal framework Nursing documentation (RAI, plan for care and services) Ethics for the professional field of action Living environment of elderly people, Safety measures Standards of Hygiene Deprivation of personal liberty, Sexuality and shame Anatomy and physiology, Relevant disease patterns Nursing aids, Personal care Emergency situations Disease patterns of memory diseases and their causes Steps of the nursing process Knowledge of the most common pharmaceuticals and their administration, reliable sources of information, e.g. Pharmaca Fennica or pharmaceutical databases, Knowledge in terminal care. Knows how to apply different forms and methods of

Helps and supports clients to

manage their daily activities

Provides basic daily health care and nursing (caring and

nursing)

Rehabilitory approach

Implements pharmacotherapy, rations and administers pharmaceuticals and monitors their effect

Measures the client or patient’s body temperature, respiratory frequency, pulse, blood pressure and blood sugar correctly and recognizes changes in the client or patient’s condition. Offer assistance in the relevant areas in the context of a resource-oriented and active care and housekeeping Perform scheduled preventive

Plans, implements and assesses the care of and services to the elderly, taking their resources and participation into account Observes the client or patient’s vital functions, sensory functions, ability to function and well-being.

Evaluation of the ability of function and services need of the older person Actively guides the client and his/her family in the use of pharmaceuticals, competence in pharmacotherapy Personal care skills Supports and guides social well-being Competence in different pharmaceuticals, regulations and provisions concerning pharmacotherapy and the limitations and requirements set by them Cooperation with relatives, families and

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communication in response to varying situations with older people and their relatives Assistance in home economics, nursing and social care sector Conflict and stressful situations Complaint Management Prophylactic measures Importance of exercise as basis of independence and self-care options Food and liquid balance, Diets Functional limitations due to age and disease Personal and unique process of dying and death Establishing relationships with relatives Laws and regulations in work safety Knowledge about service system of social and health care Knowledge of income security

measures Apply nursing aid and care techniques Take measures in daily routine to ensure independent living Document observations and measures in the nursing documentation Carry out tasks in the implementation of individual activities with the elderly Integrate activities of everyday life to preserve and promote mobility and independence Apply care aids to promote physical activity , fall prophylaxis and shift of position Use ergonomic movements Document food and drink balances Apply measures to prevent infection Set individual aids appropriately (e.g. visual aids, electronic reading aids, hearing aids ) Report physical and emotional changes Take measures for first aid in emergency situations Cooperate with relatives and social networks Use communication channels to deal with conflict and stressful

others Expertise in environment hygiene Competence in personal hygiene Promotes the elder’s life quality, monitoring the healthy lifestyle Problem solving competence Finds different solutions also to challenging situations.

Work in multi-disciplinary team., team working skills

Uses communication channels to deal with conflict and challenging behaviour

Shares appropriate information with health professionals, other team members and key stakeholders.

Teamworking by mobile devices

Terminal care. Facing death. Participates in the care of a dying elder in every respect.

Evaluation of the mental health of the older person

Interact in a dignified way Show respect and tolerance Regard the particular personality and the

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situations Ensure the quality of Service Perform work flow using the technology and equipment according to the situation Guides and advices the old persons and their relatives Promotes the rights and diversity of individuals

social environment of the individuals Hold the independence and self-care ability in high regard Reflect their role and actions and take feedback from the team Take cultural, religious and individually designed living and living areas into account Handle aids and private objects carefully Reflect experienced violence and its impact on their own professional actions under guidance Accept instructions Respect the privacy Take the person being cared for seriously Be patient and understanding (insightful) with regard to effects of age and disease Assist and support individuals to use alternative and augmentative communication systems Understands and follow of work safety principles

HHCP2 PUBLIC HEALTH NURSE

specialised care/technical nursing and coordination and supervising service provision.

3,5 – 4,5 year polytechnic education

planning of service plan Evaluation of service needs

HHCP3 REGISTERED NURSE

specialised care/technical nursing and coordination and

3,5 year polytechnic education planning of service plan Evaluation of service needs

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supervising service provision.

HHCP6 PHYSIOTHERAPIST OCCUPATIONAL THERAPIST

Rehabilitory approach

3,5 year polytechnic education Rehabilitory approach

PRACTICAL NURSE (EQF4)

ROLE: content of the work/sets of activities

theoretical and/or factual KNOWLEDGE


HOUSEHOLD WORK Living environment of elderly people Safety measures

Offer assistance in the relevant areas in the context of a resource-oriented and active care and housekeeping (cleaning, taking care of clothes ) Offer assistance in the relevant areas in the context of a resource-oriented and active care and housekeeping

information and assistance in administrative matters, etc.

PERSONAL CARE AND ACTIVITIES IN NORMAL DAILY LIFE

Rehabilitory approach Standards of Hygiene Legal framework Nursing documentation (RAI, plan for care and services) Ethics for the professional field of action

Helps and supports clients to manage their daily activities Ensure the quality of Service Perform work flow using the technology and equipment according to the situation Personal care skills Supports and guides social well-

information and assistance in administrative matters, etc. works by guidance of home care nurse and follows the caring plan Steps of the nursing process

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Deprivation of personal liberty, Sexuality and shame Anatomy and physiology, Relevant disease patterns Nursing aids, Personal care Emergency situations Disease patterns of memory diseases and their causes

being Promotes the elder’s life quality, monitoring the healthy lifestyle Problem solving competence Finds different solutions also to challenging situations.

Work in multi-disciplinary team., team working skills

SUPPORT BY OUTDOORS MOVING AND ABILITY TO FUNCTION

general knowledge about physiology and functions, Rehabilitory approach

supporting a person's by outdoors activities (by going to shop, bank etc administrative matters) Carry out tasks in the implementation of individual activities with the elderly Apply care aids to promote physical activity , fall prophylaxis and shift of position Use ergonomic movements

works by guidance of home care nurse and follows the caring plan Understands and follow of work safety principles

FUNCTIONING AND INDEPENDENT LIVING

Knowledge of income security Laws and regulations in work safety Knowledge about service system of social and health care and other service producers

Rehabilitory approach Take measures in daily routine to ensure independent living Integrate activities of everyday life to preserve and promote mobility and independence

works by laws and regulations Plans, implements and assesses the care of and services to the elderly, taking their resources and participation into account

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NURSING ASSISTANCE Anatomy and physiology, Relevant disease patterns Nursing aids, Personal care Emergency situations

Provides basic daily health care and nursing (caring and nursing) Implements pharmacotherapy, rations and administers pharmaceuticals and monitors their effect Measures the client or patient’s body temperature, respiratory frequency, pulse, blood pressure and blood sugar correctly and recognizes changes in the client or patient’s condition. Perform scheduled preventive measures Apply nursing aid and care techniques Take measures for first aid in emergency situations

works by guidance of home care nurse and follows the caring plan

COMMUNICATION AND GUIDANCE Knows how to apply different forms and methods of communication in response to varying situations with older people and their relatives

Cooperate with relatives and social networks Guides and advices the old persons and their relatives Promotes the rights and diversity of individuals Assist and support individuals to use alternative and augmentative communication systems

guides the client and his/her family, makes the caring plan together with client and her/his family

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Understands and follow of work safety principles

MONITORING AND REPORTING Knows different ICT programs, especially client program Knows the correct levels of different things like body temperature, pulse and so on.

Document observations and measures in the nursing documentation Document food and drink balances Report physical and emotional changes Measures the client or patient’s body temperature, respiratory frequency, pulse, blood pressure and blood sugar correctly and recognizes changes in the client or patient’s condition.

Teamworking by mobile devices

follows the caring plan

PHARMACEUTICALS ASSISTANCE Knowledge of the most common pharmaceuticals and their administration, reliable sources of information, e.g. Pharmaca Fennica or pharmaceutical databases,

Document observations and measures in the nursing documentation Implements pharmacotherapy, rations and administers pharmaceuticals and monitors their effect

works by guidance of home care nurse and follows the caring plan

TERMINAL CARE

Knowledge in terminal care. Personal and unique process of dying and death

comforting of client Show respect and tolerance

follows the caring plan

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EVALUATION OF THE MENTAL HEALTH OF THE OLDER PERSON

Knowledge of most common mental changes of older person

Regard the particular personality and the social environment of the individuals Hold the independence and self-care ability in high regard Reflect their role and actions and take feedback from the team Take cultural, religious and individually designed living and living areas into account

Uses communication channels to deal with conflict and challenging behaviour Finds different solutions also to challenging situations. Personal care skills

guides the client and his/her family, makes the caring plan together with client and her/his family Promotes the rights and diversity of individuals

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11 OLDER PERSONS HOMECARE IN AUSTRIA

11.1 Introduction to older persons homecare service in Austria

As of January 2013, 8,4 Milion people were living in Austria according to final results of Statistics Austria.

Life expectancy at birth stands at 81 years, one year above the OECD average of 80 years and the 18.3% of

the population is aged 65 or over in 2014 with a predicted rising trend in the ageing process over the next

decades.

Increasing longevity and declining fertility rates are expected to double old-age dependency ratios to reach

50% by 2060, so Austria has to face the challenge of rapidly increasing demand for long-term care.

In the Austrian context, the role of the public authorities is divided in several levels of statutory power, and

regulated by one federal and 9 different Lander laws. The state is federal, with powers shared between

federal and 9 provincial governments. Federal competencies are implemented uniformly in all provinces

(Länder), while provincial competencies are different among themselves. While the federal government is

predominantly responsible for designing and providing allowances, each province also takes part in setting

allowances levels. The Austrian system benefits include: benefits in cash (federal cash benefits, respite care

benefits, 24-hour care), benefits in kind (see below), and benefits for carers.

Planning in the Austrian health-care system is largely input-oriented and is – in accordance with the

fragmentation of responsibility – carried out and implemented by a variety of stakeholders.

In principle, plans for hospitals are made by the Länder on the basis of a national plan, and plans for general

and specialist care by physicians are made by the regional health insurers in agreement with the chambers

of physicians (location-based capacity plans on the basis of national guidelines from the Federation of

Austrian Social Security Institutions).

Since 2008, healthcare planning includes rehabilitation and ambulatory care, as well as long-term care,

where it interfaces with health-care provision. In addition, long-term care plans exist at the Länder level.

The medium-term goal for planning in the health sector is “needs-based planning”, where need is

calculated according to morbidity statistics.

For long-term care, legally the responsibility of the Länder, “need and development plans” are drawn up

between the federal government and the Länder on the basis of the relevant agreement in accordance with

Article 15a of the Federal Constitutional Law. The goal is to secure an adequate and varied offering of

home-based care and nursing services, as well as inpatient and mixed facilities for individuals in need of

long-term care. These plans take into consideration ambulatory and home-based services (social, medical

and nursing provision), mixed facilities (e.g. day- and night-care centres) as well as inpatient care (care

homes, homes for the elderly, shared living arrangements for the elderly, etc.), and also regulate facilities

for coordination and cooperation (e.g. administrative districts for social and health-care). Similarly to

regional structural plans, need and development plans are very diverse, and aimed at problem areas

specific to each Land.

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In Austria, family care for older people with long-term care needs has long been provided almost

exclusively by women and unremunerated. More recently, rising labour-market participation of women and

growing mobility have put this traditional model of care under considerable pressure. In 2005,

approximately 400,000 family caregivers – often burdened by their professional, personal and care tasks –

needed respite, support and social security. Some provisions targeting these issues have been introduced

over the past two decades: social insurance contributions for carers, enhanced care counselling, care leaves

for employed carers, extensions of day care and other support facilities. They have been supplemented by

payments of social security contributions for carers, but this support remains only a minor incentive for

family carers.

In 2014, an additional measure was introduced to facilitate care leaves for employees who care for a family

member that is entitled to the long-term care allowance. For up to six months the carer is entitled to the

equivalent of the unemployment benefit (55% of previous wage). Still, as care episodes are often extending

beyond this period, about 15% of family carers are reducing or completely abandoning employment, and

are often confronted with high barriers to re-enter the labour market. Despite these limitations, support to

family carers has allowed numerous older people to remain in their homes, in no small part because the

care provided by families can be supplemented with community-based formal care services: 37% of

Austrians consider professional care at home affordable, placing the country considerably above the

European average of 31% (European Commission, 2007). Long-term care allowances are shaping the

Austrian system of long-term care from care in homes to care at home.

Notwithstanding these improvements, fragmentation at the interfaces between formal and informal care,

and health and social care, remains the main barrier to deinstitutionalisation in Austria.

Social care and health care system in Austria

The legal and organisational framework is still characterised by a strict division of competences and

financing. A large variety of regional regulations affects the organisation and practices of residential care

homes and professional education standards. Decentralisation, an inherent effect of the Austrian division

of competences based on the principle of subsidiarity, is often a hindrance to coordinated action. In

practice, cooperation between acute care and providers of follow-up treatments and long-term care

services is limited. Despite the growing awareness of the need to integrate care and a series of efforts

implemented to improve the situation, coordinated health and social care projects have not moved past

the model phase.

Social care services are cross- sectional matters. Both the in-patient sector of health and social care

(hospitals, nursing homes, residential homes, etc.) and home-based social services are mainly subject to

provincial legislation and administration. The federal state must only pass elementary laws in this area,

whereas the provinces have the authority to pass and responsibility to implement laws (Art. 12(1) B-VG).

The Austrian long-term care system relies on a combination of cash and in-kind benefits to users, built

around a comprehensive system of long-term care allowances (OECD, 2005). This so-called Pflegegeld is

funded through general taxation by the federal government with the aim to improve possibilities for

independent living in case of care need.

With regard to the benefits in cash, it is allowed to use them, either to purchase formal care services from

public or private providers or to reimburse informal care giving. Additionally, provinces are required to

provide places in institutions, in day/night care centres and home care services. The social security scheme

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covers the difference between recipient’s income (including care allowance) is not sufficient to cover the

costs of care services. There are several kinds of benefits in cash:

According the federal Long Term Care Allowance Act (Bundespflegegeldgesetz, BPGG) introduced in 1993:

all persons in caring need can receive federal cash benefits. These benefits are entirely financed from taxes

and they are granted to dependent persons on the basis of seven categories of need, thus the number of

hours of nursing care per month. The minimum-requirement (level 1 benefit) is a monthly 60-hours need of

care and an expected duration of the need that exceeds 6 months. The allowance, which varies from EUR

154.20 (level 1) to EUR 1,655.80 (level 7) per month is provided regardless of income and assets.

Dependent persons who are not covered by BPGG (essentially disabled persons and social assistance

recipients) can obtain cash benefits provided by the provinces (Landespflegegeld).

In 2015 the care allowance has been granted to 457,821 persons8. The merged levels 1 (23%) and 2 (29%)

represent 51% of total beneficiaries:

Level Need of care (in hours) Amount Beneficiaries

1 Over 65 hours € 154.20 23%

2 Over 95 hours € 284.3 29%

3 Over 120 hours € 442.90 18%

4 Over 160 hours € 664.30 14%

5 Over 180 hours and permanent need € 902.30 10%

6 Over 180 hours and non-coordinable service €1260 4%

7 Over 180 hours and permanent immobility € 1655.80 2%

Source: VIDA, 2015.

The care allowance is the key feature of the Austrian system, as it allows dependent persons to finance the

freedom of choice for care.

• Respite care benefit is destined to the primary informal carers. It is provided on an annual tax-free

basis. Depending on the level, the respite care benefit can reach EUR 1,200 (levels 1 to 3), EUR

1,400 (level 4), EUR 1,600 (level 5), EUR 2,000 (level 6) and EUR 2,200 (level 7).

• 24-hour care, available for persons that organise 24-hour care. The objective of this system is to

provide assurance of nursing and care around the clock: the assistance is given to the person under

care at the household and certain tasks relating to the personal care and eating. In addition to

these tasks, under a doctor’s order a caregiver may perform certain defined medical tasks for

example the administration of drugs, bandaging and subcutaneous injections. To benefit from this

grant additionally to the cash benefit, the dependent person has to be recognised at least level 3.

The amount of this grant depends on whom the dependent person has hired: an employee (EUR

1,100) or an independent worker (EUR 550).

The benefits in kind cover a variety of services which may be bought with the cash benefits. The beneficiary

may also opt for them instead if more adapted for their care needs. Among them are:

• Mobile services: domiciliary care, home helpers, transitional care family assistance, 24-

hour care, meals on wheels, visiting service, and emergency hotlines

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• Outreach services: therapeutic services and Länder advisory or counselling centres

• Semi-institutional services: day centres

• In-patient/institutional services: short-term care, transitional care, care during the

vacations of the carer, nursing homes/residential homes/senior residences

• Services for persons with disabilities: transport service, personal assistance,

occupational therapy, and homes.

At last, there are the benefits for carers. They include paid and unpaid leave, working arrangements and

pension credits, respite care, training and education. More recently, the importance of the informal care

provision has led the Austrian authorities to set up another significant regulation: the 2007 Home Care Law,

which recognises the predominance of informal care provision in Austria, and therefore aims at creating

better regulation of informal care provision. Indeed, most persons in need of care in Austria (about 80%)

prefer staying home and receiving informal care from relatives over formal care.

Home care social services

The Art. 15a Agreement of 1993 requires all provinces to provide decentralised institutional, semi-

institutional and home-based services. For this purpose a catalogue of services and quality criteria for social

services was included in the Agreement. The provinces are also responsible for interlinking the services

offered and guaranteeing information and counselling.

The objectives of the system are the following:

• Persons in need of care should be able to choose freely among the services offered.

• The expansion of home-based services has clear priority in relation to the expansion of institution-

based facilities.

• Nursing homes should be small, decentralised and integrated into residential areas.

• The expansion of new care services/facilities has to reduce the burden of caregiving for family

members. The range of services provided is of crucial importance (e.g. day care, short-term care,

respite care).

The Austrian LTC system distinguishes between two main types of social services:

• Institutional care services, which are mainly provided by the federal provinces and local

authorities, or by religious and other non-profit organisations. These services usually include care in

residential homes, nursing homes, day-care centres and night-care centres;

• Home-care services, which are mainly provided by non-profit organisations, such as Caritas,

Diakonie, Hilfswerk, Red Cross and Volkshilfe. They include, among others, home help, home

nursing care, mobile therapeutic services, meals on wheels, transport services, home cleaning,

laundry services and weekend help. Domestic care, practical help, such as cleaning and cooking,

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and help with instrumental activities of daily living can be included in care plans designed to

provide a package of suitable home-care services. The provision of equipment, assistive devices and

technology is included in such home-care packages.

Home healthcare services

Since 1992 the health care insurance covers home nursing (which is a health service that provides

injections, nutrition via tubes, decubitus ulcer care, etc.), if the need is verified by a physician. Eligibility is

dependent on illness and the provision is limited to four weeks.

Among support measures for caregiving relatives, tthroughout Austria certified healthcare and nursing

professionals visit the homes of all recipients of long-term care benefits to inform and counsel all those

involved in the specific care situation in order to assure the quality of home care.

The care vouchers e-pilot project (quality assurance in care at home) began in October 2004. Those entitled

to receive the long-term care allowance can obtain information, advice and practical tips on the care

system and different possibilities from a home visit by a specialist care professional (Leichsenring et al.,

2009). In the first few years 63% of those who received this service reviewed the professional visit as “very

good” and 35% said it was “good”. Around another 18 225 home visits were carried out in 2009.

Education and training

In principle, the job descriptions of health professionals (excluding physicians) as well as education and

advanced training (voluntary and compulsory) are addressed in the Health and Nursing Law of 1997

(Gesundheits- und Krankenpflegegesetz, GuKG), which is overseen by the Federal Ministry of Health.

Central to this law is the description of a separate area of activity for qualified nursing personnel. Three

areas – namely those of exclusive responsibility, joint responsibility (together with a physician) and

interdisciplinary responsibility (shared with other medical professionals) – are defined (§14, §15, §16

GuKG). This is intended to clarify the tasks and liabilities of qualified nursing personnel, which includes care

assessment, diagnosis, planning, implementation and evaluation (in their area of exclusive responsibility).

In reality, however, the separation of tasks and responsibilities is less clear and handled very differently.

Also regulated in this law are the job descriptions and education of so-called ‘nursing aids’ (Pflegehelfer),

who are certified to support nurses and doctors in their work.

Regarding the education of care personnel (nurses and nursing aids), the Health and Nursing Law describes

the necessary content of nurses’ theoretical education in a quite detailed manner. With respect to care

services and their quality, such educational content as professional ethics, documentation and supervision,

the care of older persons, home-based care and so forth is explicitly mentioned. Practical education

comprises activity in hospitals, care institutions and institutions for other social or care services (e.g. home-

based services).

Nursing aids have a somewhat condensed version of the above-mentioned educational requirements (§92,

§93 GuGK).

Special education for leading and teaching care professionals is also regulated by this law (§65 GuGK).

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The required qualification for all professions in home care is regulated by the agreement on social

professions established between the federal government and federal states (Art. 15a B-VG zwischen dem

Bund und den Ländern über Sozialbetreuungsberufe, Wiener Landtag 2005). The same agreement regulates

the job tasks of nurses, home care staff, and home aids.

The Agreement on Social Care Professions (Vereinbarung über Sozialbetreuungsberufe) was signed by the

federal government and the federal provinces pursuant to Article 15a of the federal constitution in 2005. It

was a major step towards regulating professional profiles, occupational activities and training according to

common targets and principles. The agreement provides for a modular system that facilitates the

permeability of boundaries between the individual professions by increasing flexibility and mobility in the

labour market. For example, the job profile ‘home helper’ has been introduced nationwide (before, it only

existed in the federal provinces of Vienna, Lower Austria, Upper Austria and Styria, which have larger

populations). The agreement anticipates an upgrading of the social care professions, and basic quality and

education standards. People with a trade licence for providing personal assistance, working in private

homes or working as self-employed nurses may attend free supplementary occupational training while

working.

According to the current programme of the Austrian federal government, the training system in the care

sector shall be further developed. In this regard, it should reflect developments in the general educational

system. Breaks in training should be gradually phased out in favour of continuous career training with

defined interfaces, similar to the general educational system. Greater consideration of the demand for LTC

should be given during training.

Initiatives for qualification support for employees and for improving the situation of current employees

in social and health homecare

A) AMS employment campaign

The Public Employment Service (Arbeitsmarktservice, AMS), which monitors provision and demand in

various occupations has tackled the lack of personnel in the healthcare and social sector by an employment

campaign. Qualification support for employees (Qualifizierungsförderung für Beschäftigte) is financed

through this programme, which is being run within the framework of the European Social Fund.

The minimum age for attending training in social and nursing professions is 17 years. Therefore, both the

large social sector NGOs (such as Caritas and Diakonie) that are active in training and hospitals providing

training in healthcare and the nursing professions offer voluntary job finding training or social work

possibilities for up to one year to school-leavers (normally aged 15 years as compulsory education involves

nine school years).

In the framework of the upcoming structural reform of the health and care sector, up to 2014 a concise

competency model for the sector and the different professions will be developed, starting from an analysis

of the current situation and including representatives of all professions and some employers. The intention

is to ensure a nationally uniform high-quality education with at least the school-leaving examination (which

enables the student to attend university).

Qualifications required for a certain profession will meet the practical requirements of the job and will

allow for further training or career shifts within the sector (Reformarbeitsgruppe Pflege, 2012).

B) BAGS initiative

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A collective bargaining agreement has been in place since 2004 for employees working in member

companies of the umbrella organisation of employers in the health and social occupations

(Berufsvereinigung von Arbeitgebern für Gesundheits- und Sozialberufe, BAGS). According to this union,

some employers in the social and health sector have recently started to ask their employees about

satisfaction with their work.

The planned structural reform will help reduce fluctuation in the health and care sector by improving

working conditions. Plans have been made to consider the different working conditions in stationary and

mobile care and then optimise framework conditions, for example concerning working time, offering

childcare facilities, organisation of work and duty rosters (Reformarbeitsgruppe Pflege, 2012).

C) The Labour Foundation for Social Work and Healthcare Professionals

The Labour Foundation for Social Work and Healthcare Professionals is an initiative of the Vienna

Employment Promotion Fund (Wiener ArbeitnehmerInnen Förderungsfonds, Waff) and the Public

Employment Service (Arbeitsmarkservice, AMS). With this Labour Foundation, the Waff and AMS Vienna

support Viennese health and care sector companies in their search for personnel. It provides unemployed

people in Vienna with access to free vocational training in the care sector and a suitable employment

option.

Interested job-seekers get access to future-oriented occupations, such as home help, nursing assistance or

certified nursing, with the objective of obtaining a full-time or part-time employment contract after

completing vocational education.

Companies receive support through tailor-made personnel recruitment and qualification measures as well

as demand-oriented, close-to-job qualifications for future employees.

Occupational qualifications provided within this Labour Foundation involve legally regulated theoretical and

practical training, leading to the acquisition of a generally accepted qualification in the following

professions:

• Social care professions: home help workers; social workers with a specific focus (working with older

people and people with disabilities); diploma social workers with a specific focus (working with

older people, families, people with disabilities).

• Healthcare and nursing professions: certified health carers and nurses, and up to 2011, nursing

assistants (are now trained within the framework of a different AMS support model).

C) University course for case and care management

The federal province of Styria has, inter alia, introduced a university course for case and care management.

In this advanced training programme, members of the higher grades of health and nursing services are

trained to perform domiciliary nursing and care-giving tasks and to act as an interface between intramural

and extramural care systems. Furthermore, advanced training courses for the higher grades of the health

and nursing services and care assistants were developed, focusing on an “ageing society with increased

nursing and care-giving requirements”.

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11.2 HHCP involved in older persons homecare service in Austria: roles

and competences The HHCP mainly involved in the sector of mobile health and social care for older persons in Austria are:

• nurses, nurse assistants: this group belongs to the healthcare professions

• home helpers , social care workers specialized in services for elderly persons and qualified social

care workers specialized in services for elderly persons: this group belong to social care professions

Regulations on social care professions fall under the competence of the Laender. Related training

programmes and professional profiles, however, were harmonised within the framework of an agreement

on social care professions made in 2005 between the Federal Government and the Laender pursuant to Art.

15a of the Bundes-Verfassungsgesetz (Federal Constitutional Law).

The legislative fundament of nurses and nurse assistants is the federal occupation law (Berufsgesetz) 108:

Law for healthcare – GuKG 1997 (108. Bundesgesetz: Gesundheits- und Krankenpflegegesetz – GuKG 1997).

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HOME HELPER

Home helpers support persons needing assistance in performing housekeeping tasks and activities of everyday life with a view to promoting own activities and

helping them to help themselves. These activities also include assistance in basic care under the guidance and supervision of healthcare professionals.

OCCUPATION ROLE

(SET OF

ACTIVITIES)

KNOWLEDGE

know what - theoretical

and/or factual

knowledge

SKILLS

know how to do - SKILLS as cognitive (involving the use of logical,

intuitive and creative thinking) and practical (involving manual dexterity

and the use of methods, materials, tools and instruments)

COMPETENCIES

know how to be -

competence in terms of

responsibility and

autonomy, being able to

evaluate, making

judgements, managing a

complex task in a context

taking decisions, etc.

HOME HELPER

Performing

housekeeping

tasks

to know the hygiene

measures

To clean and tidy in the direct surround of the client To evaluate hygiene and

safety risks in home

environment

To support with food

and fluid intake

• to cook and prepare meals, e.g. heating frozen food,

portioning and, if necessary, cutting food, preparing snacks,

etc.

• To evaluate compliance with dietary requirements

• to give assistance with eating

• to give assistance with drinking

To evaluate the proper

foods to be cooked and

recognize of eating

disorders, difficulties in

swallowing, insufficient

fluid intake and immediate

information of the doctor

or member of the

professional level of the

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• to ensure sufficient fluid intake care service in charge

Supporting in

activities of

everyday life

To know the basics of

domestic economy

To support with shopping To evaluate the proper

foods to be bought on the

basis of economic

availability and food needs

To know documentation To support older adults in administrative practices and dealing with

authorities

To build a network around

the old person

To support in social

relations

To address the older adults to the main existing services which can

improve his/her quality of life

To give motivation and

support in self help

Assistance in

basic care

To know the basics of

personal hygiene

• to provide assistance with getting up from bed

• to provide assistance with washing

• to provide assistance with taking a shower

• to provide assistance with taking a bath

• to provide assistance with dental care

• to provide assistance with hair care

• to provide assistance with shaving

To recognize changes in the

general health status or

skin and immediate


or member of the


care service in charge style

To provide assistance

with dressing and

• to provide assistance with selecting clothing

• to provide assistance with putting on and taking off garments,

To observe persons

condition

Deliverable 2.1


undressing stockings, tights, socks, etc. and compression stockings

To provide support

related to excretions

• to provide assistance with toileting

• to provide assistance with intimate hygiene after toileting

• to provide assistance with incontinence products, e.g. changing

protective pants and assisting with pads

To recognize of changes in

excretions and immediate


or member of the


care service in charge

To support and promote

mobility

• to provide assistance with getting up or lying down

• to provide assistance with sitting down

• to provide assistance with walking

To observe persons

condition

To provide support with

positioning

• to use of aids to prevent decubitus in wheelchair users

• to use of aids to facilitate daily activities for people suffering

from rheumatic changes

To observe persons

condition

To provide support with

taking and applying

medicinal products

• to provide assistance with oral medication, which also includes

reminding the client to take medicines or taking medicines out of

a one-week dispenser

• to provide assistance with the application of prescribed

ointments, creams and lotions, etc., or of skin care products

ordered by members of the professional level of the care service.

To observe persons

condition

Deliverable 2.1


SOCIAL CARE WORKERS SPECIALISED IN SERVICES FOR ELDERLY PERSONS

Social care workers are skilled professionals helping to shape the living conditions of people who are disadvantaged in the way they lead their lives because of

their age, disability or other difficult circumstances. They have comprehensive knowledge of the diverse aspects of living with disadvantages and can provide a

broad range of counselling, support and assistance services related to all issues of life from coping with everyday life to finding a meaning to life. They provide

tasks of assistant nursing: assistant nursing education and training forms an integral part of education for this profession.

OCCUPATION ROLE

(SET OF

ACTIVITIES)

KNOWLEDGE


and/or factual knowledge

SKILLS

know how to do - SKILLS as cognitive (involving the use of logical, intuitive

and creative thinking) and practical (involving manual dexterity and the use of

methods, materials, tools and instruments)

COMPETENCIES

know how to be -

competence in terms

of responsibility and

autonomy, being

able to evaluate,

making judgements,

managing a complex

task in a context

taking decisions, etc.

SOCIAL CARE

WORKERS

SPECIALISED IN

SERVICES FOR

ELDERLY

PERSONS

To provide

support,

assistance and

services related

with daily life

To have a comprehensive

knowledge of the diverse

aspects of living with

disadvantages:

• to aid to restore, maintain and promote skill for an possible

independent life in old age

• to adopt measures to increase quality of life of older persons

• to address physical, psychological, social and spiritual needs and

resources

To contribute to

increase and / or

maintain quality of

life of older persons

To know documentation

To support older adults in administrative practices and dealing with

authorities

To build a network

around the old

person

To support in social To address the older adults to the main existing services which can improve To give motivation

Deliverable 2.1


relations his/her quality of life

and support in self

help

Providing tasks

of assistant

nursing

To perform nursing

measures ordered and

supervised by qualified

nurses

• To apply basic nursing techniques;

• To apply basic mobilisation techniques;

• To apply personal hygiene and nutrition measures;

• To make patient observation;

• To apply measures of preventive care;

• To know documentation of nursing measures taken;

• To clean and disinfection tools

To provide

knowledge and apply

methods to maintain

one’s own health

potential

To cooperate in

therapeutic and diagnostic

tasks ordered in writing by

a doctor of medicine and


nurses or doctors of

medicine:

• To administer medicines;

• To apply bandages and dressings;

• To administer subcutaneous injections of insulin and anti-

coagulants, including taking blood from capillaries for measuring

the blood sugar level by means of test strips;

• To feed tube through an existing gastric tube;

• To provide patient observation tasks required for medical reasons,

e.g. measuring blood pressure, pulse rate, temperature, weight

and excrements, and monitoring the patient’s consciousness level

and breathing; simple measures of thermotherapy and light

To provide

knowledge and apply

methods to maintain

one’s own health

potential

Deliverable 2.1


therapy,

QUALIFIED SOCIAL CARE WORKERS SPECIALISED IN SERVICES FOR ELDERLY PERSONS

Qualified social care workers perform all the activities that are also carried out by social care workers. Owing to their advanced, scientifically based education and

the competences acquired during the preparation of their diploma thesis, they are able to fulfil their tasks with a higher level of autonomy and own responsibility.

In addition to direct care work, qualified social care workers perform conceptual and planning tasks related to the organisation of care work. They provide tasks of

assistant nursing: assistant nursing education and training forms an integral part of education for this profession.

OCCUPATION ROLE

(SET OF

ACTIVITIES)

KNOWLEDGE


and/or factual

knowledge

SKILLS


and creative thinking) and practical (involving manual dexterity and the use

of methods, materials, tools and instruments)

COMPETENCIES

know how to be -


responsibility and


evaluate, making


complex task in a

context taking

decisions, etc.

QUALIFIED

SOCIAL CARE

WORKERS

SPECIALISED IN

SERVICES FOR

ELDERLY

PERSONS

Planning and

designing the

care work

To develop on the basis

of scientific knowledge

concepts and projects, to

perform independently

and evaluate them.

• Age-appropriate transformation of the living environment.

Consulting and procurement of appropriate aids and remedies

as well as organization of the necessary government agencies or

insurance way.

• Special entertainment programs for small groups and individuals

to promote motor skills through movement exercises.

Improve the social

climate among the

inhabitants and to the

caregivers.

Deliverable 2.1


• Special entertainment programs to promote brain performance.

• Developing strategies in the event of acute crisis situations, such

as at death of relatives or roommates, depression and suicidal

behavior, confusion and disorientation.

To provide

support,

assistance and

services related

with daily life

To have a

comprehensive

knowledge of the diverse

aspects of living with

disadvantages:

• To aid to restore, maintain and promote skill for an possible

independent life in old age

• to adopt measures to increase quality of life of older persons

• to address physical, psychological, social and spiritual needs and

resources

To contribute to

increase and / or

maintain quality of life

of older persons

To know documentation To support older adults in administrative practices and dealing with

authorities

To build a network

around the old person

To support in social

relations

To address the older adults to the main existing services which can improve

his/her quality of life

To give motivation and

support in self help

Providing tasks

of assistant

nursing

To perform nursing

measures ordered and


nurses

• To apply basic nursing techniques;

• To apply basic mobilisation techniques;

• To apply personal hygiene and nutrition measures;

• To makepatient observation;

• To apply measures of preventive care;

• To know documentation of nursing measures taken;

• To clean and disinfection tools

To provide knowledge

and apply methods to

maintain one’s own

health potential

Deliverable 2.1


To cooperate in

therapeutic and

diagnostic tasks ordered

in writing by a doctor of

medicine and supervised

by qualified nurses or

doctors of medicine:







• To provide patient observation tasks required for medical

reasons, e.g. measuring blood pressure, pulse rate, temperature,

weight and excrements, and monitoring the patient’s

consciousness level and breathing; simple measures of

thermotherapy and light therapy,




health potential

NURSE ASSITANTS

According to GuKG 1997 § 84 (see section “regulation”) the services of care assistants compass:

• the accomplishment of care measures

• the assistance with (health) care measures including the social support of patients and clients and the accomplishment of housekeeping activities.

• the accomplishment of (health) care measures may only be done under instruction and observation of members of the higher civil service for healthcare.

Off-site instructions are to be given in written form.

Deliverable 2.1


OCCUPATION ROLE

(SET OF

ACTIVITIES)

KNOWLEDGE


and/or factual

knowledge

SKILLS


and creative thinking) and practical (involving manual dexterity and the use

of methods, materials, tools and instruments)

COMPETENCIES

know how to be -


responsibility and


evaluate, making


complex task in a

context taking

decisions, etc.

NURSE

ASSISTANT To perform

nursing

measures

ordered and

supervised by

nurses

To accomplish of (health)

care measures

• to apply basic nursing techniques;

• to apply basic mobilisation techniques;

• to apply personal hygiene and nutrition measures;

• to apply patient observation;

• to apply measures of preventive care;

• to do documentation of nursing measures taken;

• to care, clean and disinfect tools




health potential

Co-operation in

therapeutic and

diagnostic tasks

ordered in

writing by a

doctor and

To accomplish of (health)

care measures








health potential

Deliverable 2.1


supervised by

nurses or

doctors



• To provide patient observation tasks required for medical

reasons, e.g. measuring blood pressure, pulse rate, temperature,

weight and excrements, and monitoring the patient’s

consciousness level and breathing; simple measures of

thermotherapy and light therapy,

NURSES

In Austria the activity of nursing and titles of the nurses are protected by law. By Paragraph 12 (1) of the law on nurses all those complying with the training

required by the law6 (the general care nurse training) are entitled to use the title [Berufsbezeichnung] “Diplomierte Gesundheits- und Krankenschwester” /

“Diplomierter Gesundheits- und Krankenpfleger” [qualified nurse].

For exercising their profession, qualified nurses in general care have acquired the following professional competence comprising expertise and methodological

competence as well as instrumentation and technical competence. Based on the tasks of nursing care, the professional competence is structured into individual-

related, organisation-related and society-related competence.

Deliverable 2.1


OCCUPATION ROLE

(SET OF

ACTIVITIES)

KNOWLEDGE



SKILLS

know how to do - SKILLS as cognitive (involving the use of logical,

intuitive and creative thinking) and practical (involving manual

dexterity and the use of methods, materials, tools and instruments)

COMPETENCIES

know how to be -


responsibility and


evaluate, making


complex task in a

context taking

decisions, etc.

Activities

managed on

nurse’s own

responsibility

• To know matters

of diagnosis,

• to plan, organize,

implement and

supervision all

measures of care

in the process of

care

• To apply procedures like anamnesis and diagnosis of care,

implementation of measures of care and evaluation of care,

but also documentation of the process of care.




health potential

Activities with

shared

responsibility

The physician bears

responsibility for the issuing

of orders, the nurse bears

responsibility for

implementing it. Doctor’s

orders must be given in a

written form; only in

exceptional, medically

• To administer drugs,

• To prepare of injections and to setting catheters




health potential

Deliverable 2.1


NURSE

justified cases can the order

be issued orally. Matters

under shared responsibility

might well be of greater

significance than those under

the nurse’s own

responsibility.

Interdisciplinary

activities

Interdisciplinary activities are

those that concern not solely

areas of care but other areas

of the health service.

The nurse here will have the

right of initiation and co-

decision and in turn, again,

the responsibility for the

implementation of the

measures of care.

To apply procedures like health counselling, advice and care during and

after a physical or mental illness

To prepare patients for the departure from the hospital and assistance

if continued care is needed.

Deliverable 2.1


11.2.1 References

• BMASK, National Report on the Implementation of UNECE-RIS for MIPAA, 2007-2012, 2011

• The European Observatory on Health Systems and Policies, Home care across Europe, Current

structure and future challenges, 2012

• Eurofound, More and better jobs in home-care services, European Foundation for the

Improvement of Living and Working Conditions, 2013

• VIDA (Gewerkschaft), www.vida.at

• Quality of jobs and services in the Personal care and Household Services sector in Austria,

European Project 4 Quality, 2015

• European Centre for Social Welfare Policy and Research, From care in homes to care at home:

European experiences with (de)institutionalisation in long-term care, 2015

• Sozial Ministerium, National Social Reports Austria, 2014

• Sozial Ministerium, Social Protection in Austria, 2014

• Bundesministerium für Gesundheit, Healthcare professions in Austria, 2016

• ENEPRI, Research report No. 69: The Long Term Care System for the elderly in Austria, 2010

• ENEPRI, Research report No. 105: Quality assurance policies and indicators for long-term care in

the European Union – Country report: Austria, 2012

• Report of the Independent Expert on the enjoyment of all human rights by older persons, Rosa

Kornfeld-Matte, Human Rights Council Thirtieth session – General Assembly of United Nations,

2015

• European Observatory on Health Systems and Policies , Health system in transition (HiT) – Austria

Health system review, 2013

• The European Observatory on Health Systems and Policies, Public health in Austria, 2011

• Caritas, Long term care in Austria – Home care Eurpe Conference, Vienna, 2009

• Eurybase The Information Database on Education Systems in Europe, The Education System in

Austria, 2008-2009

• Vereinbarung gemäß Art. 15a B-VG zwischen dem Bund und den Ländern über

Sozialbetreuungsberufe (Agreement on Social Care Professions made between the Federal

Government and the Laender pursuant to Art. 15a of the Federal Constitutional Law), Federal

Law Gazette I No. 55/2005

• Gesundheits- und Krankenpflegegesetz (Nursing Act), Federal Law Gazette I No. 108/1997

Deliverable 2.1


12 OLDER PERSONS HOMECARE IN BELGIUM

Belgium, with a population of about 11 million inhabitants, faces demographic change in a strong

manner. Between 2013 and 2060, the share of people aged 80+ will grow from 5.3% of the

population to 8.9%, with most of this growth happening before 2045. The population 85+ will more

than double, from 2.4% to 5.2%. Life expectancy for men and women at age 65 will rise from 17.4

and 20.9 years to 22.3 and 25.7 years.7

12.1 Introduction to older persons homecare service in Belgium

Belgium is a federal state, meaning that responsibility for health care generally and long-term care

specifically is split between the regions, communities and the federal level8. The federal public health

insurance, INAMI, covers many of the non-medical costs of long term care provision: help in the

activities of daily living, both at home or in a care residence. Services financed through the public

health insurance involves participating in the health care costs, this is also true for long-term care

provisions. The amount that has to be paid personally is reduced for certain categories of persons,

who are covered by a ‘maximum billable amount’. These concern both people with low income and

with chronic health conditions.

For older people, the federal level pays a ‘benefit for the support of older persons’ (‘allocation d’aide

aux personnes âgées’ / ‘tegemoetkoming hup aan bejaarden’) that is allocated to persons over 65

with low or modest incomes and who show certain reductions in their activities of daily living. In

Flanders, this help is topped up by a mandatory ‘long-term care insurance’, which can pay 130 euros

to every person with severe or partial limitations in their capacity to be autonomous.

In 2006, about 50% of long-term care patients were taken charge of in care institutions (public,

private not-for-profit and private for-profit). Home care is provided in proportion to the restriction of

activities of daily living and includes the provision of services which compensate for capacity loss,

such via the provision of service vouchers. Service vouchers are subsidized partially by the federal

government. Service vouchers also exist for the general population, allowing to receive tax

reductions of about 2/3 of an hourly cost for the purchase of household services such as ironing or

cooking – these vouchers are also used by older people with limitations, but as the system exists for

the whole population, it is not known how much care is financed via this system. The exact offer of

services varies between the regions.

Semi-residential services for people who stay at home exist and consist in short-stay or day care

centres. The number of home care users has grown by more than 20% between 2000 and 2011

7 SPC report on long term care

8 https://www.oecd.org/fr/sante/systemes-sante/48432045.pdf

Deliverable 2.1


Informal care stays important in the Belgian system: in 2006, about 9.4% of the population over 15

years of age was caring informally for another person, the majority being women aged between 45

and 60 years. Informal can reduce their working time (full-time or part-time leave) all while receiving

a monthly benefit, and maintaining their coverage of social security rights. Every employee can also

draw on 10 days of unpaid leave for ‘imperious reasons’ per year, for example in the case of the

hospitalization of a person living in the same household.

12.2 HHCP involved in older persons homecare service in Belgium:


According to the Social Protection Committee’s 2014 report on long-term care, nursing care is

organised by the federal public health insurance system. Nurses need to be qualified and many are

self-employed. In 2012, about 175.000 qualified nurses were registered, 4.200 of them with a special

qualification in geriatric care. Nurses are helped by care professionals, who form structured teams

with nurses.

Non-medical services in home care are organised locally by staff employed by a public agency or

private non-profit companies. The subsidized home care sector produced about 25 million care hours

in 2006, equivalent to 17,000 full-time workers.9

In 2002, the Federal Government introduced the “Integrated Home Care Services” (‘Geïntegreerde

Diensten Thuiszorg (GDT)’ / ’Service Intégré de Soins à Domicile (SISD)’), which are financed by the

statutory health insurance system. This structure coordinates all medical disciplines involved in the

care for patients for a specific geographical area.

At the regional level, home care is coordinated by ‘Cooperation Initiatives Primary Care’

(‘SamenwerkingsInitiatieven Eerstelijnsgezondheidszorg’ or SELs) in Flanders and by the

‘Coordination Centres for Home Care and Services’ (‘Centres de Coordination de Soins et Services a

Domicile’ or CSSDs) in Wallonia. Their main task is to guarantee the quality of care and the

cooperation between staff involved in providing LTC to people in their own homes such GPs, home

nurses, accredited services for home care and home help, aid for the elderly and social work, etc.

In Flanders, a policy of coordination and cooperation between residential and home care services is

implemented through the Act on Residential and Home Care (‘Woonzorgdecreet’, 2009). The

legislative framework combines self-care, informal care and professional care in existing and new

forms of home care; care that supports home care, and additional care and residential care.

9 SPC report on LTC

Deliverable 2.1


12.2.1 Nursing auxiliary (‘aide soignant’)

Nursing auxiliaries help nurses to provide hygienic care to patients: weighing, taking temperature, measuring heartbeat etc. Nursing auxiliaries have a legal

status, an official vocational training pathway and can perform certain tasks that are generally performed by nurses, by delegation.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Monitoring: Observe and signal physical,

psychological or social changes of the patient

Observe the functioning of body sensors Observation Medical skills

Psychological skills

Emotional skills

Observation of oral hydration

Observation of the pulse and body temperature

Hygiene and prevention Dental hygiene Technical non-medical skills Emotional skills

Install and remove orthopaedic tights

Hygienic care for stomas

Application of measures to prevent bodily injuries

Application of measures to prevent infections

Application of measures in prevention of small injuries

Assistance in activities of daily life

Help in nutrition and hydration Skills in assistance, driving Psychological skills

Emotional skills

Transport of patients

Help in taking medicine

Assistance in the work of other health professionals

Installation and observation of patients in a functional position with technical support

Technical medical skills

Assistance of the patient in case of non-sterile taking of samples of secretions/excretions

Deliverable 2.1


Counselling Assist the patient and his/her community in difficult moments

Psychological and emotional skills Knowledge of the health-care system

Emotional skills

Inform and advise the patient and his/her family according to the care plan on the authorized

technical services

12.2.2 Nurses

Nurses are qualified by a bachelor-degree academic training. All over Belgium, high schools (‘Haute Ecoles’/’Hoogeschools’) are training nurses alongside

some universities. A difference is made in training between nurses generally and nurses in a hospital environment specifically, the latter ones requiring a

higher qualification level. Nurses are employed by hospitals and can establish themselves as an independent profession, which intervene in the home

environment as well. To be established as an independent nurse, nurses have to comply with the formalities linked to self-employment and, most

importantly, receive a registration number from the Belgian federal health insurance (‘INAMI number’), which is limited in quantity. According to the

European sector directive 2013/55/EU, nurses will have to have absolved 4600 hours of training, including 2300 hours minimum of professional practice

with patients to be qualified, as well as to know 8 key competences identified in the Competence Framework of the European Federation of Nurses. The

directive will enter into application in Belgium from September 2018.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Medical tasks Comprehensive knowledge of the sciences on which general nursing is based, including sufficient

understanding of the structure, physiological functions and behaviour of healthy and sick

persons

Competence to independently initiate immediate measures to pre-serve life and to carry out measures in crisis and disaster situations

to plan, organize and implement nursing care when treating patients

Deliverable 2.1


Knowledge of the nature and ethics of the profession and of the general principles of health and nursing

Competence to independently advise, instruct and support

individuals needing care and their attachment figures

Competence to independently diagnose the nursing care required using current theoretical and clinical knowledge as well as

Competence to independently ensure the quality of nursing care and assess it

Playing in a team of health care professionals

Clinical experience under the supervision of qualified nursing staff and in places

where the number of qualified staff and equipment are appropriate for the

nursing care of the patient

Competence to work together effectively with other players in the

health sector

Experience in working with health personnel and other professions in the health sector

Competence to communicate comprehensively and

professionally and to cooperate with members of other professions

in the health sector

Life-long learner Competence to analyze the quality of care in order to improve their own professional practice as general care nurses

Ability to participate in practical training of health personnel

Counselling of patients Competence to empower individuals, families and groups

towards healthy lifestyles and self-care

Deliverable 2.1


12.2.3 Social Assistants

Social assistants assess the situation of each patient and detect their needs, and participate in the planning of care and support the other professionals that

go to provide home care. The minimum qualifications are to have completed a Bachelor’s degree in social assistance and to have a driver’s license

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Organisation of help to the patients

Ability to detect needs of the patient Preparation of a support plan Systematised and structured working

Knowledge of the medical and social environment and available support

services

Organisation of family support services, cleaning services etc.

Listening and availability for the patient and his/her family

Evaluation of the patient’s situation and change of the support plan if necessary

Critical thinking

Management of service providers

Management of the time planning of the team Information management

Information management on new demands/needs

Maintenance of relationships with professionals

Lead monthly team meetings Human resources skills, communication skills

Deliverable 2.1


12.2.4 Family helper (‘aide familiale’)

Family helpers need to be in the possession of a certificate about their capacity to be a family helper, certifying the participation in a number of trainings on

secondary-school level (‘auxiliaire familiale’). The ministry of health delivers certificates of registration as family helpers. Another requirement is a driver’s

license.

Together with patient’s guardians (‘garde malade’) and household support workers (‘aide ménagère’) and drivers, they provide the support in activities of

daily living that go beyond medical tasks: cooking, housekeeping, helping the patient change positions, personal hygiene, mobility etc. Some of these tasks

are provided under the service voucher system, others are part of personalized care plans.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Help in daily activities Preparing meals Shopping

Housekeeping

Hygiene and medical tasks Personal hygiene tasks Help in movements (change in positions)

Communicate and inform on hygiene and ergonomic adaptations of the

household

Social and relational tasks Help in administrative matters Organize the patient’s budget

Orientation towards specialized services

Listening to the patient Supporting the patient

Counselling in difficult situations

Monitoring Look for signs of maltreatment or elder abuse

Monitor the health status of the patient

Competence in observation

Deliverable 2.1


12.3 Sources:

Organisation for Economic Cooperation and Development. H’elp wanted? Providing and Paying for

Long-Term Care. Key findings and lessons learnt: Belgium’ In: OECD Healthy Policy Studies, 18 May

2011, , https://www.oecd.org/els/health-systems/47877421.pdf (consulted on 20 May 2016).

European Union, Adequate social protection for long-term care needs in an ageing society. Report

jointly prepared by the Social Protection Committee and the European Commission, 2014,

http://ec.europa.eu/social/BlobServlet?docId=12808&langId=en (consulted on 20 May 2016).

Aide-soignant.be, Liste des activités que l’aide-soignant peut effectuer sous le contrôle de l’infirmier/-

iere et dans une equipe structurée, http://www.aide-soignant.be/wp-

content/uploads/2014/01/residentialcare101.pdf (consulted on 25 May 2016).

European Federation of Nurses, EFN Competency Framework for Mutual Recognition of Professional

Qualifications Directive 2005/36/EC, amended by Directive 2013/55/EU,

http://www.efnweb.be/?page_id=6897 (consulted on 25 May 2016).

Centrale des services à domicile et services associées, Assistant social,

http://www.fcsd.be/ToutUnMetier/IntegrerNotreEquipe/DecouvrezNosMetiers/Pages/assistant-

social.aspx (consulted on 25 May 2016).

Centrale des services à domicile et services associées, Aide familiale,

http://www.fcsd.be/ToutUnMetier/IntegrerNotreEquipe/DecouvrezNosMetiers/Pages/aide-

familiale.aspx (consulted on 25 May 2016).

Deliverable 2.1


13 OLDER PERSONS HOMECARE IN BULGARIA

13.1 Introduction to older persons homecare service in Bulgaria

In Bulgaria, according to the statistics, life expectancy at birth reached 74.33 years in 201410. The life

expectancy of those over 65 is 14.8 years, which is the lowest in the EU and the disability adjusted life years

are comparatively low (WHO/HFA,23-03-2010). The low population density and the negative population

growth rate are poor circumstances for service development and informal care.

Despite a period of rapid economic growth after accession in 2007, Bulgaria is still the poorest country in the

EU (Genet et al. 2013). Citizens as well as medical professionals are dissatisfied with the health care system;

equity is a challenge not only because of differences in health needs, but also because of socioeconomic

disparities and territorial imbalances. The insufficiency of the services at the moment finds expression in the

inadequate coverage by the operative organizations and programs. There are areas in the country where

patients do not have access to such a service (Yanakieva et al., 2014). The decrease of medical care personnel

(shortage of medical nurses, physicians, rehabilitation specialists etc.), particularly in small towns and remote

populated areas restricts the access to medical help and quality healthcare services to patients in those areas.

According the researches made amongst the medical professionals as well as bed-ridden patients in, the

majority of the population would not take advantage of homecare unless it is being financed by an institution

or family and close relatives due to the impossibility to allocate enough money from the personal budget. This

is the reason why the provision of Medical Home Care should be a priority in developing the relevant

legislation (Yanakieva et al., 2014)

Healthcare is mainly privately provided, while public providers and NGOs provide social services. Most of the

healthcare services are provided by medical institutions, having contracts with the National Health Insurance

Agency. It not envisaged that NGOs delivers health care services, but this causes often problems of

coordination since very often the clients need and integrated social-medical service.

In Bulgaria the governmental policy on home care is weak and no policy paper has exclusively addressed

homecare. Within Bulgarian cultural tradition, it is considered the duty of families to take care of their elderly

relatives even though this is not a legal obligation. Anyway, the situation of care dependent elderly people

furthermore suffers from the decreasing availability of informal care, which not just results from demographic

developments but also from large scale emigration of younger people.

Usually, healthcare services and social services are separately provided. Hospitals, homes for the elderly and

hospices are not involved in homecare. By lack of public financial resources social and health care services

often require private payments. But Bulgarian elderly persons are the poorest in Europe and for many of them

this is an obstacle to access to services they need (Genet et al. 2013).

10 http://www.indexmundi.com/bulgaria/life_expectancy_at_birth.html

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13.1.1 Home healthcare in Bulgaria

Home health care is not well developed in Bulgaria; it is managed under the Ministry of Health and provided

by GPs and practice nurses.

Although making home visit is an official task of GPs and their practice nurses, covered by the basic health

insurance, such home visits are sparsely made due to the lack of time and are anyway not enough to meet all

needs. Home nursing is unknown in most parts of the country. In fact, formal home nursing services are

delivered on a very limited scale by GP nurses and by nurses employed by NGOs. Nurses exclusively working in

organized home care services are very scarce , while hospital nurses may provide privately paid home nursing

care as a sideline job to those who can afford.

GPs decide whether nursing homecare should be provided to the patient or not, but there are no uniform

national eligibility criteria for this choice.

13.1.2 Social homecare in Bulgaria

As organized nursing services at home are rare in Bulgaria, home care is often considered limited to social

services.

Provision of personal care and domestic aid is mainly public or private not-for-profit.

The provision of social services activity is under the joint responsibility of the Ministry of Labour and Social

Policy and the municipalities, which manage and organize the service at local level. To apply for personal care

and domestic aid no doctors referral is required. Application for these services are usually submitted to the

local Social Assistance Agency. Other Options for submissions are the municipalities and the NGOs.

Personal care, domestic aid and technical aid are only available for people with a disability holding a nationally

regulated certificate of being disabled (meaning to have lost the ability to work for at least 50%) (Panayotova

2009).

Most home social services arrangements in Bulgaria are part of the following three schemes, each applying its

own eligibility criteria (Genet et al. 2013).

A. Home Social Patronage

Home Social Patronage is a national scheme managed by municipalities aiming to provide basic care to frail

populations, like elderly, poor and disabled people, including (Salonen & Kinos, 2012):

- provision of food, i.e. daily hot meals and a diet suitable for the elderly;

- maintenance of hygiene at home;

- assistance in supplying the necessary technical aids for the sick and disabled people for health

monitoring, measurement of blood pressure, etc.

- assistance in purchasing food and basic necessities, pay bills, etc.

- assistance with applications in the “Social Assistance” (see point 2) directorate and other health

institutions, disability or serious illness;

The social patronage is a type of community based social service financed from the municipal budget (with

municipal financial means). It is possible for the municipality to directly provide this type of service by

establishing a municipal organization for this purpose or to contract out the delivery of the service to a private

provider.

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To get this service people needs to be disabled, over 65 years old, unable to organize ones living needs,

without close relatives taking care and not own a home. Very often municipalities deliver directly home social

patronage service, but sometimes they contract out or outsource to private providers, mainly NGOs (Genet et

al. 2013).

Social Patronage services are provided by professional workers, such as social workers, domestic aids and

rehabilitators.

B. Social Assistance

The Social Assistance Agency developed a national program called the “Social assistant”, which is the only

operative national program covering the social aspect of the Medical Home Care (Salonen & Kinos, 2012).

The Social Assistance scheme enables the provision of personal care and support and domestic aid to gravely

ill persons and to disabled people by Personal Assistants. The inclusion into the program of patients is open

only to persons not using social services such as Personal Assistant or Social Assistant delivered by other

organizations, companies or donor’s programs.

Personal assistants are informal carers receiving financial support from the Social Assistance program, run by

municipalities. This program provide employment for unemployed persons to alleviate the situation of families

in which a disabled person is in need of constant care. The Social Assistant create the conditions for the social

inclusion of people with disabilities, providing a qualified assistance to them and their families by supporting

the maintenance and development of strengths and positive characteristics in the value system of the person

and by promoting self-reliance (Salonen & Kinos, 2012).

To become “Social Assistants to persons with disabilities” unemployed people are trained for only a couple of

days for assistance work.

C. Social Services in the Home Environment

The recently established national programme “Social Services in the Home Environment” is locally managed by

the municipalities and is focused on social activation and on light household support (for instance,

administration). One of the goals of the program is to ensure additional training and employment of persons

who already have experience as social assistants or people helping in clients’ household. Each Home Helper

serves several clients. The Home Helpers spend equal time in each client’s household, regardless the

differences in clients’ needs (Genet et al. 2013).

In general, it is not possible to combine the use of Services from different schemes. In addition to national

schemes, municipalities may develop their own additional social assistance programmes.

There are no special rehabilitation programmes funded by the government, though most new community

services – day-care centres, protected housing, rehabilitation centres – include rehabilitation programmes

and focus on physical aspects of “recovery”

13.1.3 The role of NGOs and Bulgarian Red Cross

The NGOs play a key role in the realization of the democratic participation principles. A major characteristic of

those organizations is their independence from the State and other social sectors. Beside the independence,

the NGOs hold a varied and precious experience in areas providing reliable and stable development of society

(Genet et al. 2013).

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In Bulgaria, an important role is played by the Bulgarian Red Cross (http://en.redcross.bg). It implements an

integrated model of complex provision of health and social cares at the homes of older people and people with

disabilities. This model is based on the experience of the Swiss association "Spitex" and has successfully been

adapted to Bulgarian conditions. The center for home care analyses and evaluates the needs of patients

,organizes staff training, provides the services and monitors their quality. The staff of the Home Care centers

consists of nurses and home-helpers trained in the specific aspects of care provision in home environment.

The nurses provide some primary health cares - taking blood pressure, control of heart activity, bandages,

while the services provided by the home-helpers include: maintenance of personal and home hygiene,

shopping, feeding, paying bills, support in administrative procedures, etc.

An important aspect of the activities of the Home Care centers is the support of the patients’ capacity for self-

help as well as the training of their family members in how to provide the cares needed. In addition, the BRC

has also developed teams of volunteers at each Home Care Center, who support actively the provision of

services at the homes of the beneficiaries after going through a special training.

The Bulgarian Red Cross is the only organisation whose as they call them ‘home nurses’ and ‘home helps’

(personal care and domestic aid) have followed additional training specifically on home care (supported by the

Swiss Red Cross). A mandatory requirement for working at the Home Care centers is the training provided

both to nurses and home-helpers prior to their appointment. The BRC is licensed at the National Agency for

Professional Education and Training for the provision of a professional training in the following specialty

“Social services for children and older people with chronic diseases, physical and sensor impairments” which

has two modules: “Home-helpers and Hospital Attendants” and the second module – “Social Assistant”. The

training is focused on the specific aspects of care provision in home environment. The training programs are

elaborated with the support of the Swiss Red Cross, they are in conformity with the European requirements in

this field and have been adapted to the conditions in Bulgaria. Trainers in the trainings are lecturers from the

Medical University in Sofia and members of the Bulgarian Association of Professionals in Nursing Cares.

13.1.4 “Home Care and Assistance Services towards Independent and Dignified Life” Project

The Bulgarian Red Cross is currently implementing, in the capacity of an Executing Agency (EA) in partnership

with the Ministry of Health, Ministry of Labour and Social Policy and the Swiss Red Cross , the “Home Care and

Assistance Services towards Independent and Dignified Life” Project (2012-2017). The goal of the project is to

support the introduction in Bulgaria of a model for complex provision of health cares and social services at

home as a form of long-term care for older people with chronic diseases and permanent disabilities drawing

on the Swiss experience.

Except for provision of home care services to beneficiaries in the target region and improving of their quality of

life, the project aims at establishing an institutional framework for sustainable provision of this type of services

in Bulgaria, incl. proper legislative regulation, payment mechanisms, national quality standards and unified

training programs for the staff. Among the main priorities of the project is to raise the awareness on home

care services at all levels of the Bulgarian society in order to validate them as a form of integrated provision of

health and social services to older people with chronic diseases and disabilities.

One of the main results of the project was achieved in September 2015 when the legal changes elaborated by

the Bulgarian Red Cross jointly with the Ministry of Health and Ministry of Labour and Social Policy were

adopted by the Parliament. The texts approved in the Health Act regulated for the first time in Bulgaria the

integrated provision of health and social services for various target groups at home, among them older people

with chronic diseases and disabilities, pregnant women and children. The next step will be the establishment

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of an expert group with regard to the elaboration of the sub-legislative regulation. According to the texts

adopted in the Health Act, the organization, provision, control of home care services, training requirements,

criteria for selection of beneficiaries, etc. should be regulated by a joint order of the MH and MLSP in 2016

(Bulgarian Red Cross website http://en.redcross.bg )

13.2 HHCP involved in older persons homecare service in Bulgaria: roles

and competences

NURSES

The lack of reports describing activities and responsibilities of nurses doesn’t permit to define in detail the

roles and competences of nurses homecare in Bulgaria and this is one of the issues raised from Home care

across Europe case study on Bulgaria (2011) that has been pointed out as obstacle to allow nurses work

independently. Based on available information, nurse in homecare perform health education, administrative

tasks supporting GP and health assistance, including injection and wound treatment. They are involved in

different work setting including public services in collaboration with GP, despite very limited, NGOs, social

services delivered by municipalities and privately. Nursing study program in Bulgaria is a full-time four-year

nursing course leading to a Bachelor of Science in nursing. There are no specific regulation for the homecare

services certification.

Nurses have to take training courses and other accredited forms of continuous training annually organized by

BAPZG (Bulgarian Association of Health Care Processionals) and Medical University-Sofia /Post graduated

training department.

As an upper margin, the education for nurses encompasses at least 4.600 hours of education and a minimum

amount of 180 ECTS. Participation in the Bologna Process aims to make academic degree standards and quality

assurance standards comparable.

In Bulgaria, the main providers of nursing education at initial level are medical colleges. The training is held

according to the modern curriculum and syllabus which answer the European and world standards. After

Bulgaria signed the Bologna Declaration [1999], the three-tiered higher education model (Bachelor’s, Master’s,

and Doctoral degrees) was introduced on account of the amendments and additions put forward in the new

Higher Education Act [Popova et al., 2011]. Since 2007 nursing study program in Bulgaria is a full-time four-

year nursing course leading to a Bachelor of Science in nursing. Once obtained this degree a nurse can provide

homecare: no specific training is envisaged for homecare nurses (IENE Project website -

http://www.ieneproject.eu/ ).

No specific information about Bulgarian nurses competences have been retrieved.

HEALTHCARE ASSISTANT11

The regulation of competences of nurses, midwifes and other associated medical specialists and health

assistants was accepted on February 8th 201112. This regulation describes the professional activities

11

Source: EU-Project: Creating a pilot network of nurse educators and regulators (SANCO/1/2009) - Country Profile Bulgaria - Health Assistanthttp://www.hca-network.eu/downloads/Country%20Profile%20Bulgaria%20131004.pdf 12

Ordinance No 1 of 8th February 2011 for occupational activities that nurses, midwives, associated medical specialists and medical assistants may operate as appointed or self- organized, issued by the Ministry of Health From 18th February 2011.

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that health assistants are supposed to perform on doctors’ or nurses’ order or without supervision.

State educational requirements for acquiring qualification in the profession of "Healthcare Assistant",

specifies requirements for the acquisition of third-level qualification for the specialty "Health care".

Until now there is no compulsory examination for the target group. In future the Ministry of Education

will plan a project to make their education compulsory, and in that course there will be compulsory and

structured examination.

Health assistants service the patients by assisting them in feeding, toileting, transporting and providing

comfort and good hygiene in the patients’ room.

Services to patients through assistance, including: nutrition; a common toilet; transportation and support for

examinations; normal daily activities; providing comfort and hygiene in the hospital environment. Professional

activities that health assistants may perform in sterilizing units are preparing material for surgery and other

material for sterilization in accordance with the approved working rules for chemical and microbiological

control of the sterilization process.

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Common to the profession

"Healthcare Assistant"

Observe the rules for health and safety and protect the environment in performance of their duties

Applicable regulations (Health Law, Medical Establishments Act, Ordinance No 1 of 08.02.2011, the Ministry of Health) in the provision of basic health care

Effectively communicate with patients

Effectively communicate the work team

quality standards Provide care in accordance with the quality standards

Respond appropriately in stressful situations

Show a willingness to upgrade their professional competence and develop their personal qualities

Competencies on the physiology and pathophysiology of the human

Knowing the physiology and pathophysiology of the human anatomy (by system)

Named symptoms of the most common acute surgical conditions

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Knowing the symptoms of orthopedic and traumatic conditions

Knowing the most common diseases of the internal organs

Performing in health care for specific diseases of internal organs

Knowing physiological conditions of the child and the pathological changes in different diseases

Performing activities related to the child's physiological state and pathological changes in disease

Making self-care infectious and cancer

Performing activities where necessary to provide emergency medical care

Collecting, recording and processing data

Competencies related to general patient care

Knowing the structure and organization of medical work

Knowing applicable regulations and standards for better health care

Performing independently of the patient types toilet

Complying with the provisions of the dietitian for medical nutrition patient

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Monitoring and recording the activity of the excretory system

Competences on hygiene rules and standards in hospitals

Applying basic rules of asepsis and antisepsis

Performing disinfection of surfaces, objects and hospital linen

Participating in activities of prevention of hospital-acquired infections (nosocomial infection)

Knowledge on social and legal relationship of the health assistant

SOCIAL ASSISTANT

Social assistant is a person providing a set of services focused on social work and counselling to the clients and such needs as leisure time organisation

and social contacts (Mincheva & Kanazireva, 2010). Clients are: persons with permanently impaired working capacity to the extent of 90% and over, entitled

to “assistance of other people”; children with 50% and over impaired social adaptation ability entitled to assistance by other people; severely ill single

elderly people experiencing autonomy difficulties, certified by a Medical Expert Board Protocol; adults or children leaving specialised institutions for

disability. The distinction between social, home and personal assistant has not been laid down (Toptchiyska & Vasileva 2009). All three professions are described

as persons providing meals, domestic aid and monitoring of the health status in the home environment and providing information to the GP (Toptchiyska &

Vasileva 2009).

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Social work

to know the basics of domestic economy to go grocery shopping to evaluate the proper foods to be bought on the basis of economic availability and food needs to know the basics of nutrition principles

to cook meals

to know the basics of personal hygiene to provide personal hygiene

to know the basics of hygiene in home environment (cleaning, food etc.)

to clean home environment

Administrative support

to know the basics about the administrative practices related to aging/disability management


Liaison with GPs to help with taking medicines

Social participation To organize time of clients

To foster clients social participation

PERSONAL ASSISTANT

According to the legal definition this is a person providing permanent care to a child or elderly person with some kind of a permanent disability or to an

elderly person with a permanent disability, or to a severely ill person for the purpose of meeting that person’s everyday needs. Personal assistants are

usually persons of working age and co-habitant family member of recipient. No specific education or training is needed.

The distinction between social, home and personal assistant has not been laid down (Toptchiyska & Vasileva 2009). All three professions are described as persons

providing meals, domestic aid and monitoring of the health status in the home environment and providing information to the GP (Toptchiyska & Vasileva 2009).

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ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Social work

to go grocery shopping

to cook meals

to provide personal hygiene and personal care in general



to know the basics about the administrative practices related to aging/disability management (e.g. Rules for the Implementation of the Social Assistance Act)


Daily living facilitation to help the client with eating

To help the client with moving around

HOME HELPER

The “Home Helper Service” has been introduced since the beginning of 2009 as part of the National Programme “Social Services in a Family Environment”. Home Helpers are normally working for NGOs. The Bulgarian Red Cross (BRC), through the National Training Center, provides trainings for them. The home helper is a person who provides services at home, focused on the maintenance of hygiene in the home, shopping and cooking, washing and other everyday activities. These services are intended for people with different kinds of disability (regardless of age) whose health constraints lead to their isolation and/or inability to look after themselves and organize the everyday activities.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

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Social work

to know the basics of domestic economy to buy food, medicines and vital items with money provided by the recipient of the services

to evaluate the proper foods to be bought on the basis of economic availability and food needs

to know the basics of nutrition principles to cook meals

to know the basics of personal hygiene to provide personal hygiene

to know the basics of hygiene in home environment (cleaning, food etc.)


to carry out small repairs at home and/or to provide assistance in their execution

Administrative support to support older adults in paying bills and

taxes

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13.2.1 References

Bulgarian Red Cross website http://en.redcross.bg

EC, 2013, Mapping and analysing bottleneck vacancies on EU Labour Markets

ec.europa.eu/social/BlobServlet?docId=12645&langId=en

Genet, N., Boerma, W., Kroneman, M., Hutchinson, A., & Saltman, R.B. (2013). Home care across Europe. Copenhagen: WHO, Regional Office for Europe (on behalf of the European Observatory on Health Systems and Policies) http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf

Mincheva L. & Kanazireva G., The System of Long-Term Care in Bulgaria (May 28, 2010). ENEPRI Research Report No. 71. Available at SSRN: http://ssrn.com/abstract=2033694 or http://dx.doi.org/10.2139/ssrn.2033694

Salonen, K. & Kinos, S., Good practices and visions of the future of home care work in Bulgaria, Finland, Greece and Turkey. EQUIP II (2010-2012). 2012. Turku Education Department & Turku Vocational Institute.

Toptchiyska, D. & Vasileva, E. 2009, Report on transferability in Bulgaria of the model for the validation of competences acquired as a result of professional experience for occupations in the social sector, developed in Italy within the project “Care Talents”, Balkanplan Ltd, Bulgaria.

Yanakieva, A. Y.; Vodenitcharova, Y. Y.; Bancheva, M. A. (2014): Need of the Service Medical Home

Care and Perspectives for Public-Private Partnership in Bulgaria. In: Planet@Risk, 2(4), Special

Issue on One Health: 298-302, Davos: Global Risk Forum GRF Davos.

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14 OLDER PERSONS HOMECARE IN CROATIA

14.1 Introduction to older persons homecare service in Croatia

Similar to other European countries, Croatia is bearing how their elderly are growing in population. In 2016

the number of people living in the Republic of Croatia reached 4,254,008. Life expectancy is currently at

75.8 years (above average of global expectation which, according to Population Division of the Department

of Economic and Social Affairs of the United Nations, is at 71 years old). And the ratio births/deaths has

been coming across a constant decrease of 0.08 % for the past 4 years. This means 16.9% population is over

the age of 65. Thus, age dependency ratio in Croatia reaches now 24.8% (data from U.N. Statistics Division).

By 2031 the share of older people was estimated in a range from 21.8% to 25.4% (the later, in the worst of

prospects).

Professional home care has traditionally been under the scope of work of family doctors teams. From 1993

Home Care Nursing Service (HCNS) was introduced as separate health care institution under the supervision

of patients´ personal doctor. Long-term care (LTC) in Croatia is mainly organized within the social welfare

system. Most of it is financed from the State budget (96%), while the remainder comes from out of pocket

payments of the beneficiaries and from local and regional self-governing units, and includes sanitary

transportation and home care. The initial patient´s needs assessment, before the HCNS starts home care, is

done by the personal family doctor and public health nurse. Frequency of nurse visits is also determined by

the Croatian Health Insurance Institute (CHII) regulation, usually within a range of 2-5 times a week during

several months. Physical therapy at home is also part of the NCHS, but for this service the recommendation

from the specialist of physical medicine is required. The standard number of inhabitants per one nurse and

per one physical therapist at home is set by CHII regulation, as well. The users are mainly elderly over the

age of 70 and are mostly satisfied with the service, even though they do not have any possibility to freely

choose the providers, institution and nurse.

The Social Care Act (Croatian law for social care and health care issues in force since 1998) includes

provisions on generational solidarity, which are to keep the elderly in their own homes and with their

family; promote their social inclusion; and improve their quality of life by developing and expanding non-

institutional services and volunteering. Spouses still play an important role in the provision of informal

personal care. In Croatia, spouses, especially wives, are the primary caregivers for the elderly, without any

fees. Informal caregivers are not recognized in the expenditure system (in 2012 only 5.8 % of 65+ were

covered by eldercare system). Nevertheless, there is still a large number of the elderly population who live

alone and who are at risk of having unmet LTC needs. Informal care is also provided by friends and

neighbors. Recipients of social assistance and welfare are divided into two basic categories: (1) those who

earn no income or whose income is below a certain threshold; and (2) persons who receive assistance

(financial and other).

The quantity of health personnel (nurses, physiotherapists, etc.) of the NHNCS for this network is planned

according to geographical distribution of inhabitants, geographical characteristics and local circumstances,

with huge regional differences in their distributions. Large cities and cities which are the seats of counties

are obliged to provide other types of material support and assistance, including the promotion of

volunteering and the work of civil society organizations. There are 10 categories of social services (benefits

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in kind), regulated by the CHII including in-home assistance and home care and comprise the different

types of medical treatment, delivery of meals, housework and assistance with personal hygiene. It is

awarded to persons with secured housing but who are, due to old age, affected by disability or other grave

health conditions, unable to take care of their personal needs alone or with the help of their family. The

condition for receiving this social service is that the assistance cannot be obtained from their parents,

spouse or children, nor based on life maintenance and support agreements or other regulations. A range of

institutionalized forms of care, such as permanent or temporary accommodation, or even daily or shorter

stays in care centers, is also available. There are various pensioners’ associations organized at national,

regional and local levels. The continuing problem of LTC in Croatia is that it is dispersed between the health

and social welfare systems, which has a negative impact on the accessibility, recognizability and adequacy

of the provided services.

At present, long-term care is still split between the health care system and the social welfare system. It is

important to point out that the implementation of the Strategic Plan of Palliative Care Development in the

Republic of Croatia 2014-2016 continues. The Ministry of Social Policy and Youth published three

invitations to submit projects and programs in 2014 relating to various forms of care for the elderly,

including the financing of three-year programs of civil society organizations for the provision of the service

"Hello for Help" for the elderly, organizing daily activities for them in local communities, and the services of

transport for the elderly to medical institutions and other relevant institutions, and the services of advising

the elderly about the potential harmful effects of contracts of maintenance for life or contracts of

maintenance until death. In 2014, the Ministry of Social Policy and Youth financed in total 78 projects and

programs attempting to increase the quality of life of the elderly.

Any health care professional with college degree and five years of experience is allowed to enter into the

business, either publicly financed through a contract by the Croatian Health Insurance Found (CHIF) or paid

by the user´s fees only. The vast majority of Croatian workers providing LTC in institutionalized settings or

privately employed by families, are women.

Regarding professional educational framework the Croatian model of Education complies with university

study programs and qualification standards designed according to recommendations, directives and

regulations of the European Union and the World Health Organization, adjusted to specific requirements of

the educational process in the Republic of Croatia. Croatian Qualifications Framework (CROQF) was

referenced to European Qualifications Framework (EQF) in 2014 and meet with Bologna process.

• The Ministry of Science, Education and Sports is the main governing body in Croatia. (Public

university study programs are self-accredited by the university senates).

• The National Council for Higher Education is an advisory body of the Croatian Parliament who

manages the development and quality of higher education.

• The Agency for Science and Higher Education (ASHE), an independent public authority, is the

accrediting authority of programs offered by the private higher education institutions, school of

professional higher education and polytechnics.

Basic nursing education is attained at the secondary school level. The program includes subjects

such as Croatian language, geography, history and arithmetic, with just a few hours per week of medical

sciences and clinical practice. Nurses qualify from these programs at the age of 18 and receive a license to

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practice. There is a wide variety of courses (two, three and four-year programs). Studying is possible on a

full-time basis, as “evening school” in addition to regular work and even “week-end” courses.

According to the Croatian university practice and the Law on professional Titles and Academic Degrees any

health study program should continue on three levels, following the scheme 180+120+180 European Credit

Transfer and Accumulation System (ECTS).:

• Undergraduate Study (Bachelor Degree) for Nursing, Physiotherapy, Midwifery, Radiologic

Technology and Medical Laboratory Diagnostics. To enroll in this program applicants are required

to meet the academic entrance requirements which include the completion of four-year secondary

education (Level 4 or higher) and the result of the State Graduation Test (Matura Exam).

• University Graduate Study (Master Degree) for Nursing, Physiotherapy and Radiologic Technology

• University Postgraduate Study (Doctoral Degree) Research, following related professions,

participation in nursing education, etc.

As for non-formal and informal learning the CROQF validates by an ordinance a link to NQF mainly for adult

and higher education as a craftsperson. Complying with EQVET equivalences, Level 2 would allow a

Vocational Training Certificate; Level 4.2 Upper secondary general education school leaving certificate; or

Master craftsman Diploma; Level 5 Professional Higher Education Diploma, and so on.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971660/

14.2 HHCP involved in older persons homecare service in Croatia: roles

and competences

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OCCUPATION - HCCP ROLE (SET OF ACTIVITIES)


knowledge



HHCP1 Non-Formal /

Informal Careers (EQF Level 0 to 2)

Environmental monitoring

To know basics on how to do housework.

To keep hygienic conditions of the customer´s personal environment.

To use cleaning products in a proper way

To do daily housework To have a positive attitude if the elderly person is untidy

To know basics of hygiene in home environment (cleaning, food etc.)

To remove risks on not keeping the house clean

To evaluate risks while keeping the hygiene of the home environment

Health monitoring

To know basics on how to deliver meal services

To follow instructions on how to deliver meals correctly

To be able to care for meal services maintenance

To know how meal delivery services should proceed

To take action when meal service delivery is incorrect

To solve minor disorders when meal service delivery is unfit

To know basics physical and mental health conditions

To report any health risk (to whom, how, with what times)

To manage the situation while health professionals arrive to take over.

To know basic ways of communicating risk conditions

To take action to reduce the risks To be patient with mentally or physically disabled

To report any health risk (to whom, how and when)

To communicate correctly those health risks to the elderly person and/or other personnel involved

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Activities of daily living support

To have basic ideas about domestic economy

To do shopping To be motived to give advices about food to buy on the basis of economic


To know basics of nutrition

To have a basic knowledge regarding physical and mental conditions of older adults during accompaniment (falls risk

assessment)

To accompany when going out Ability to overhaul the older adults conditions before and during the

accompaniment

To have a basic knowledge of socialization process

To promote socialization Ability to evaluate and assess a

socialization process

Values and principals

To have basic knowledge of disrespectful or inappropriate

circumstances

To report unethical situations (to whom, how and when)

Ability to evaluate tampering by others

To take action to reduce unethical situations

To reinforce equality, diversity and transcultural approaches

HHCP2 Adult Education

(EQF Level 0 to 2) Environmental monitoring





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Health monitoring










To do shopping To be motived to give advices about food to buy on the basis of economic

availability and food needs To know basics of nutrition


assessment)


accompaniment




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circumstances





HHCP3 Volunteers

(EQF Level 0 to 2)









Health monitoring










To do grocery shopping To be motived to give advices about food to buy on the basis of economic


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assessment)


accompaniment






circumstances





HHCP4 Physiotherapy

technician/masseurs (EQF Level 0 to 2)

Activities for physiotherapy

treatments

To know massage/physiotherapy techniques

To apply physiotherapy/massage techniques

To give positive suggestions to work team

HHCP5 Nursing Bachelor´s Degree (Level 4.2)


To know about home environment safety

To report environmental risks (to whom, how, with what times)

To guide ways of avoiding risks on home environment safety

To know good hygiene habits in home environment (cleaning, food etc.)

To report hygiene risks (to whom, how, with what times)

To evaluate appropriately the risks of unhygienic home environment

Deliverable 2.1


To take action to reduce the risks To interact with the elderly person in order to reinforce self-protection

Health monitoring

To know the main indicators of risky conditions for physical and mental health (sudden illness, accidents, spread of infection, etc.)


To properly evaluate a mental and physical risk in home environment

To take action to reduce the risks To have a patient attitude in order to develop good habits

To know how to help in medication adhesion

To provide planning schedules as reminders of medication

To interact for healthy behaviors in medical prescriptions

Equipe working

To know healthcare organizations and services for older adults

To guide the older adults on principals and existing services in the area that can make life easier

To motivate the usefulness / necessity of activation of a service.

To know how to support individuals according to their personal care/support plan

To provide individuals with information to enable them to choose the way they want to be supported

To ask for help from appropriate personnel when not confident or skilled in the role to carry out.

To know how to activate formal and informal support networks to stimulate active and healthy lifestyle

To maintain social connection with medical personnel, social worker, neighbors and volunteers

To have communication skills and involvement of the older adults in the interactions.

To know the role of other health/home care professionals

To be able to respect other health/home care professionals´ indications

To encourage the elderly to communicate with the network

Deliverable 2.1



To know the values and principles of adult social care

To know how to keep privacy of customer´s physical/ mental conditions

Reflect on holistic work practices

To know about administrative practices related to aging management

To support in complying fiscal practices and other practices relating to the older adults

To foster positive attitudes in fulfilling public rules

To know the importance of the elderly person´s privacy

To keep privacy about the elderly person´s reports

To respect the elderly person´s decisions


Activities for chair based exercise

To know nutrition principals To make personal nutritional plans To assess foods on economic availability and food needs

To Know physical and mental conditions of older adults during accompaniment

(falls risk assessment) To assess on accompaniment risks

To suggest possible needs of devices or apparatus

To know how to identify, respond to and escalate changes to physical, social

and emotional needs

To report changes to the correct professional , (to whom, when and

where)

To motivate readaptation of the elderly person after changes

To monitor Socialization process To know how to evaluate and assess

a socialization process To have the ability to promote

socialization

To know local and national strategies for safeguarding and protection from

abuse

To recognize potential signs of different forms of abuse

To support and challenge unsafe practices

Deliverable 2.1


To report abuse (to whom, when and where)

To know the barriers to communication (non-verbal communication,

importance of active listening, etc.)

To know how to avoid barriers to communication

To establish ways to communicate with the individual. (Establish signs,

gestures, marks, communication boards, etc.)

To know structures and mechanisms of the human body in its development stages, in health and disease

To inspect carers under charge for correct practice

To have the ability of identifying erroneous treatments.


To know how to keep privacy of customer´s physical/mental

conditions Reflect on own work practices

To know how to be aware of dementia To report risks of dementia in older people (to whom, when and where)

To have the ability of approaching dementia without hurting sensibilities

To know the factors that can influence communication and interaction with individuals who have dementia

To know how to cope with individuals with dementia

To treat individuals with dementia under equal rights

To know quality methods and procedures

To inspect quality of services To encourage quality services to be

kept

Activities for older adults with special

health needs

To know how to be aware of older people with diabetes

To monitor diabetes To know how to prevent diabetes

and/or early detection

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To know how to manage symptoms in end of life care

To prepare a life care plan

To know how to support individuals with loss and grief before death and/or specific communication

needs

To provide positive feedback to avoid doldrums or depressions

HHCP6 Physiotherapist

Bachelor´s Degree (Level 4)

Activities for physical therapy treatment

To know humanistic and holistic approach to the individual undergoing physical therapy treatment

To act according to the defined or observed needs

To be sensitized to individual needs and desires of the clients

To assess the status of clients and the need for physiotherapeutic treatment

To apply the selected physiotherapeutic procedures according to the clients’ needs

To approach his activities in accordance with ethical code of

national physical therapists To carry out kinesiometric and other measurements for the diagnosis of musculoskeletal and other systems functions

To plan and program physiotherapeutic procedures

To evaluate treatment effects To participate in team work,

continuing professional education, and promotion of the profession.

To keeps records of clients´ treatments To assure the privacy of records To participate in prevention

activities

Activities concerning assessment to physiotherapy

technicians/messeurs

To assess the nature of most convenient physiotherapy treatment

To monitor team work To give positive advice to improve

treatment

Deliverable 2.1


HHCP7 Nursing University Degree (Master´s

Degree)


To know home environment safety rules

To inspect monitoring environmental rules



To inspect that hygiene rules are complied with

To suggest how to comply with hygiene rules in a right way

To take action to reduce the risks To interact with the elderly person in order to reinforce self-protection

Health monitoring

To know principal methods used in scientific research

To apply principal methods used in scientific research

To encourage the use of new methods used in scientific research

To know structures and mechanisms of the human body in health and disease



kept

To know main indicators of risky conditions for physical and mental health (sudden illness, accidents, spread of infection, etc.)

To inspect monitoring of health risk To evaluate that mental and physical to avoid risks in home environment are being followed

To take action to reduce the risks To suggest changes in actions being taken

To know rules for medication adhesion

To inspect monitoring of planning schedules as reminders of medication

To suggest changes for healthy behaviors in medical prescriptions

Deliverable 2.1


Equipe working


To guide other professionals on principals and existing services in the area that can make life easier

To seek, understand and motivate information and use it creatively in problem solving

To know support networks to stimulate active and healthy lifestyle

To follow up maintain of social connection with medical personnel, social worker, neighbors and volunteers

To have communication skills and involvement of other professionals in the interactions.

To monitor the role of other health/home care professionals

To monitor other health/home care professionals´ indications are being followed

To communicate in academic and clinical contexts (even in the English language)

To perform continually as a teacher for health staff and patients

To be able to communicate health-related information

To be able and willing to act as role-model.

Teaching/Managing approach

To know the values and principles of adult social care and medical laws

To inspect that customer´s and other professionals´ privacy is being complied with

To observe the rules of conduct of the institution

To know administrative practices related to aging management

To inspect reports are correctly fulfilled

To communicate clearly in both verbal and written form for acuteness in reports

To know medical informatics To understand fundamentals of the patient medical history

To communicate clearly with colleagues (including physicians and allied health professionals)


To inspect privacy monitoring of the elderly person´s reports

To suggest corrections on how to monitor privacy

To know nutrition principals To inspect personal nutritional plans

monitoring To make suggestions for foods on

economic availability and food needs

Deliverable 2.1


To know devices and appliance equipment for elderly people

To inspect that appliance equipment and devices are being used correctly

To assess workers under their charge on how to monitor de use of

mechanical devices or appliance equipment

To know how to inspect Socialization process

To evaluate and assess a better socialization process to other

professionals monitoring the process

To have the ability to reconsider possible changes in socialization

process

To know and recognize accurate diagnosis algorithms

To know how to communicate diagnosis, treatment and prognosis

to patient, patient´s family and other health professionals

To have the ability to work in a team and give and execute orders with

respect

HHCP8 Physiotherapist University Degree (Master´s Degress)


















To evaluate improvement of physiological treatments

To study continually new methods

Deliverable 2.1


14.2.1 References

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971660/ (Table 3)

http://www.zvu.hr/strucni-studij-fizioterapije/?lang=en

15 OLDER PERSONS HOMECARE IN CYPROS

15.1 Overview on the older persons homecare service in Cypros

Population rates in Cyprus are as follows:

• Total population as of 1 January, 2016: 1,177,091.

• Population over 65 years old: 10.4 % (122,235 persons over 64 years old).

• Dependency ratio for people over 65 years of age is 14.2 %. Women represent the largest number and

proportion of elderly people.

• Total life expectancy at birth: 77.8 years. (Above the average of global population: 71 years, according

to Population Division of the Department of Economic and Social Affairs of the United Nations).

• Cyprus became an independent sovereign republic in 1960. The constitution institutionalized

communal dualism between the Greek and Turkish communities on the island in al spheres of

government activity. Turkey occupied the northern part of the island in 1974, thus part of the country

follows Greek habits and traditions whilst the other part follows Turkish traditions.

• According to labor force survey data, in 2011, foreign workers, including EU-27 nationals, represented

22.2 % of the total employment.

Home care nursing in Cyprus was first provided by mental health nurses in 1985. In the decade of 80s-90s, day

centers were established with the help of local voluntary organizations and municipalities. Home care nursing

services began in 2004 for people who qualified under the law “The Safeguarding and Protection of the

Patients´ Rights Law”, 2004, article 6 (b). The Home Care Nursing program (community nurses) provides short

term care (2 months) and long term care (more than 2 months). The nursing interventions provided include

measurement of vital signs, change of wounds, removal of stitches, injections, check of glucose levels, health

counseling, monitoring medicine prescription, personal hygiene, taking preventive measures, modification of

the environment and blood collection. There are several nursing specialties: Community Psychiatric Nurses,

Community General Nurses, Health Visitors, PASYKAF (specialized nurses for patients with cancer), but no

specialization for Home Care, therefore when visits to the elderly people are necessary they is provided by

community general nurses.

Home care for the elderly is organized by the Social Welfare Services. Within the services for public assistance,

the elderly and the disabled, public legislation incorporates employment incentives to encourage social

inclusion and gradually end the reliance of public assistance recipients on public funds. The Social Welfare

Services materialize a project which is co-financed by the European Social Fund and the Government of Cyprus

through which public assistance recipients receive training. Upon its completion they are expected to be

placed in the labor market. They have incorporated several programs in this regard: 1) Public Assistance, 2)

Deliverable 2.1


Services for the Elderly and the Disable, 3) Schemes offered by the service for Public Assistance, the Elderly

and the Disabled, 4) Benefits and Services provided to the Enclaved and 5) Composition of Social-economic

reports.

Social Welfare Services are in charge of home-care, day-care and residential care services. It is provided to

people entitled to public assistance benefit or people who cannot meet their special needs by their income.

The people interested in receiving the services have to fill in the Public Assistance Application Form and submit

it to their District Social Welfare Services Office.

The government encourages local communities and non-governmental organizations to develop supportive

services on the local level in order to accommodate the needs of the people of their communities. Social

Welfare Services employ carers but they can also be employed by Community Councils or may be self-

employed. The salary of the carers of the last two categories is paid by the Public Assistance Fund. Home care

service provides personal hygiene, house-cleaning, washing the clothes, shopping, cooking, payment of bills,

etc. but compared to the community nursing staff they are not educated or experts on the health/nursing

care.

Day-care service is aimed for people unable to care for themselves. They can spend their daytime at their local

day-care center where they are offered cooked meals and laundry facilities. These centers are operated by the

Community Welfare Councils and are financed by the Scheme of State Funding.

Residential Care is strictly provided to people when their individual needs cannot be met on a 24 hour basis by

their family or other supportive services. They can be governmental, community or privately owned residential

homes. The Social Welfare Services are responsible for the registration and supervision for privately and

community owned residential homes.

A public program namely “Community Organization and Development” is aimed towards the organization and

development of the communities, organized groups and voluntary organizations. This program also promotes

the Institution of Community Welfare Councils on a local, regional and national level. They receive technical

and financial assistance through the Grants in Aid Scheme from which Day Care Centers can benefit.

Education in Cyprus.- Available from pre-primary to postgraduate levels. Primary (grades one to six) and lower

secondary (grades seven to nine) are compulsory until the student reaches the age of 15. In upper secondary

education (grades 10 to 12) which lasts for three years, there are two types of schools: the unified lyceum and

technical schools. Tertiary education, including postgraduate courses, is provided at three public and four

private universities, and several private colleges and institutions provide courses at the post-secondary non-

university level. Most students prefer to follow general education due to the prejudice against technical

occupations. Moreover, the economy is mainly focused on the service sector declining manufacturing sector,

so this has led to a decline in the number of students in technical schools.

VET education.- The Ministry of Education and Culture (MoEC) has overall responsibility for the development

and implementation of educational policy. The Ministry of Labor and Social Insurance (MLSI) has overall

responsibility for labor and social policy. The Human Resource Development Authority (HRDA) plays an

important role in vocational training. The HRDA is a semi-governmental organization whose mission is to

create the prerequisites for the planned and systematic training and development of the human resources.

Deliverable 2.1


The Foundation for the management of the European lifelong learning programs is the body which manages

education programs and promotes the goals and the EU education and training policies in Cyprus.

The earliest level at which VET is available is the upper secondary level at technical schools. VET is also

available through the apprenticeship system, which accepts students who leave formal education between

grades 8 to 10. VET training is extensively available for employees, the unemployed, other vulnerable groups

and adults in general through a mixture of public and private provision such as colleges, training institutions,

consultancy firms and enterprises.

• New Modern Apprenticeship: A two year initial VET program (embracing two levels: preparatory and

core) provides practical and theoretical training, mostly for young people from 14 to 25 years of age,

who have not successfully completed their secondary compulsory education (and/or second grade of

Gymnasium and have reached their 15th year of age) and wish to be trained and employed in technical

occupations. It is focused on the current needs of the labor market (i.e. builders, plumber/welder, auto

mechanic, auto electrician, furniture maker/carpenter, electrician, domestic appliances repairer and

hairdresser). They receive the apprenticeship certificate when they successfully complete the course.

This certificate allows access to several regulated occupations.

• Elderly Care Vocational Certificate (ECVC): Certificate for informal, paid assistants and formal carers e-

learning program, aimed at assisting the elderly people in Cyprus and abroad. The Piraeus Chamber of

Commerce and Industry in Greece supervises the theoretical and practical training of the trainee care

workers that leads to an accepted EU level qualification.

• VET upper secondary level: The duration of studies is three years for both types of course (theoretical

pathway and practical pathway). School leaving certificates are awarded upon successful completion of

either programs and are equivalent to secondary general education schools. Therefore they are eligible

for admission to universities and other tertiary education institutions.

• VET at post-secondary level: As part of the education reform, in 2012/13, the MoEC in cooperation with

the MLSI and other stakeholders promoted a further technical specialization. (One and two-year

programs including practical training in enterprises).

• There are several other types of formal education, such as Evening technical schools, Public institutions

of tertiary education (Higher Hotel Institute of Cyprus, Forestry College, Tourist Guides School, Cyprus

Police Academy, naming just a few), Training for the unemployed, and Training for other groups at risk

of exclusion from the labor market.

NQF framework implementation was completed quite recently (2013) and regulated professions have fully

transposed the new Directive into national law (one for the general recognition of regulated professions and

seven others for sectoral professions (nurse responsible for general care, dental practitioner, veterinary

surgeon, midwife, architect, pharmacist and doctor)

Deliverable 2.1


15.2 HHCP involved in older persons homecare service in Cypros: roles and competences

OCCUPATION - HCCP ROLE (SET OF ACTIVITIES)


knowledge

SKILLS know how to do - SKILLS as

cognitive


HHCP1 Non-Formal /

Informal Carers ECVC Certificate (EQF Level 2-5)









Health monitoring










To know about normal physical deteriorating conditions in the elderly people

To know (how, when and to whom) report specific deteriorated conditions

To be able to give a positive view to the elderly person about the issue

To know basics about specific illnesses such as Parkinson, Arthritis, pneumonia, Diabetes, Alzheimer diseases

To know (how, when and to whom) report suspicions about existing diseases

To give a positive view to the elderly person on how to cope with the disease

To know about incontinence To know how to use specific products

To be patient with the incontinent person

Deliverable 2.1








To do shopping To be motived on giving good advice

about food to buy on the basis of economic availability and food needs



assessment)


accompaniment






circumstances





Deliverable 2.1





To know the purpose of being a home carer

To manage the specific needs of the elderly person to be cared for

To have a positive attitude towards the elderly

To know basics about specific illnesses such as Diabetes, Parkinson, Pneumonia Alzheimer diseases

To know (how, when and to whom) to report intuition of possible specific illnesses

To have a positive attitude forwards elderly people with specific illnesses

HHCP2 Non-Formal /

Informal Carers Adults/NMA & others

(EQF Level 4-5)









Health monitoring To know basics on how to deliver meal services









Deliverable 2.1




To be able to give a positive view to the elderly person about the issue

To know basics about specific illnesses such as Parkinson, Arthritis, pneumonia, Diabetes, Alzheimer diseases

To know (how, when and to whom) report suspicions about existing diseases


To know about incontinence

To know how to use specific products

To be patient with the incontinent person







To do shopping To be motived on giving good advice

about food to buy on the basis of economic availability and food needs



assessment)


accompaniment




Deliverable 2.1


To know fire safety risks To know how to avoid fire risks To have the ability of preventing fire

risks



circumstances








To know the purpose of being a home carer

To manage the specific needs of the elderly person to be cared for

To have a positive attitude towards the elderly

To know basics about specific illnesses such as Diabetes, Parkinson, Pneumonia Alzheimer diseases

To know (how, when and to whom) to report intuition of possible specific illnesses

To have a positive attitude forwards elderly people with specific illnesses

HHCP3 Community General

Nurse (EQF Level 6-8)


Health monitoring

To know about home environment safety

To report environmental risks (to whom, how, with what times)



To report hygiene risks (to whom, how, with what times)

To interact with the elderly person in order to reinforce self-protection



Deliverable 2.1


To know good hygiene habits for personal self-care

To give instructions to informal carers or relatives on how to keep good hygienic habits

To interact with the elderly person on how to keep clean.




To know the holistic approach to home care nursing and community-based nursing care

To apply the holistic approach to home care nursing

To find creative proposals for the elderly persons needs



To be able to find positive guide ways to the elderly person

To know specific illnesses such as Parkinson, Arthritis, pneumonia, Diabetes, Alzheimer diseases

To know handle with existing diseases


To know about incontinence

To know how to use specific products

To give suggestions on how to settle inconveniences

To know risky conditions in and out of the elderly persons home

To take action to reduce the risks To explain correctly how to avoid risks to the elderly and other persons involved in the caring

To know how to avoid risky conditions


Equipe working




Deliverable 2.1








To know the role of other health/home care professionals

To be able to respect other health/home care professionals´ indications

To encourage the elderly to communicate with the network









To keep privacy about the elderly person´s reports

To respect the elderly person´s decisions


Activities for chair based exercise

To know nutrition principals To make personal nutritional plans To assess foods on economic availability and food needs

To Know physical and mental conditions of older adults during accompaniment

(falls risk assessment) To assess on accompaniment risks

To suggest possible needs of devices or apparatus

To know how to identify, respond to and escalate changes to physical, social

and emotional needs

To report changes to the correct professional , (to whom, when and

where)

To motivate readaptation of the elderly person after changes

Deliverable 2.1


To monitor Socialization process To know how to evaluate and assess

a socialization process To have the ability to promote

socialization

To know local and national strategies for safeguarding and protection from

abuse



To report abuse (to whom, when

and where)

To know the barriers to communication (non-verbal communication,

importance of active listening, etc.)


To establish ways to communicate with the individual. (Establish signs,

gestures, marks, communication boards, etc.)

To know structures and mechanisms of the human body in its development stages, in health and disease

To inspect carers under charge for correct practice

To have the ability of identifying erroneous treatments.




To know how to be aware of dementia To report risks of dementia in older people (to whom, when and where)


To know the factors that can influence communication and interaction with individuals who have dementia

To know how to cope with individuals with dementia

To treat individuals with dementia under equal rights



kept

Deliverable 2.1


Activities for older adults with special

health needs

To know how to be aware of older people with diabetes and other specific diseases

To monitor specific disease To know how to prevent specific disease and/or early detection


To prepare a life care plan

To know how to support individuals with loss and grief before death and/or specific communication

needs

To provide positive feedback to avoid doldrums or depressions


Bachelor´s Degree (Level 6)

Activities for physical therapy treatment

To know humanistic and holistic approach to the individual undergoing physical therapy treatment

To act according to the defined or observed needs

To be sensitized to individual needs and desires of the clients

To assess the status of clients and the need for physiotherapeutic treatment

To apply the selected physiotherapeutic procedures according to the clients’ needs

To approach the activities in accordance with ethical code of

national physical therapists To carry out kinesiometric and other measurements for the diagnosis of musculoskeletal and other systems functions

To plan and program physiotherapeutic procedures

To evaluate treatment effects To participate in team work,

continuing professional education, and promotion of the profession.

To keeps records of clients´ treatments To assure the privacy of records To participate in prevention

activities

Deliverable 2.1


Activities concerning

assessment to physiotherapy

technicians/messeurs

To assess the nature of most convenient physiotherapy treatment

To monitor team work

To give positive advice to improve treatment

HHCP5 Nursing University Degree (Master´s Degree Level 7-8)


To know home environment safety rules

To inspect monitoring environmental rules



To inspect that hygiene rules are complied with

To suggest how to comply with hygiene rules in a right way

To take action to reduce the risks To interact with the elderly person in

order to reinforce self-protection

Health monitoring




To know structures and mechanisms of the human body in health and disease



kept

To know main indicators of risky conditions for physical and mental health (sudden illness, accidents, spread

To inspect monitoring of health risk To evaluate that mental and physical to avoid risks in home environment are being followed

Deliverable 2.1


of infection, etc.) To take action to reduce the risks To suggest changes in actions being taken

To know rules for medication adhesion

To inspect monitoring of planning schedules as reminders of medication

To suggest changes for healthy behaviors in medical prescriptions

Equipe working


To guide other professionals on principals and existing services in the area that can make life easier

To seek, understand and motivate information and use it creatively in problem solving

To know support networks to stimulate active and healthy lifestyle

To follow up maintain of social connection with medical personnel, social worker, neighbors and volunteers

To have communication skills and involvement of other professionals in the interactions.

To monitor the role of other health/home care professionals

To monitor other health/home care professionals´ indications are being followed

To communicate in academic and clinical contexts (even in the English language)

To perform continually as a teacher for health staff and patients

To be able to communicate health-related information

To be able and willing to act as role-model.


To know the values and principles of adult social care and medical laws

To inspect that customer´s and other professionals´ privacy is being complied with

To observe the rules of conduct of the institution






Deliverable 2.1





To know nutrition principals To inspect personal nutritional plans

monitoring To make suggestions for foods on

economic availability and food needs





To know how to inspect Socialization process

To evaluate and assess a better socialization process to other

professionals monitoring the process

To have the ability to reconsider possible changes in socialization

process


To know how to communicate diagnosis, treatment and prognosis

to patient, patient´s family and other health professionals

To have the ability to work in a team and give and execute orders with

respect


University Degree (Master´s Degress)










Deliverable 2.1


15.2.1 REFERENCES

http://www.euro.who.int/__data/assets/pdf_file/0008/181799/e96757.pdf

www.cedefop.europa.eu/files/4118_en.pdf

http://countrymeters.info/en/Cyprus

http://www.mlsi.gov.cy/mlsi/sws/sws.nsf/All/51950D3157907F4AC2256E7700387B35?OpenDocument&print

http://infocyprus.com/citizen/social-welfare/disability-and-illness/long-term-care-services

http://study.com/articles/Home_Care_Assistant_Job_Description_Duties_and_Requirements.html









To evaluate improvement of physiological treatments

To study continually new methods

Deliverable 2.1


16 OLDER PERSONS HOMECARE IN CZECH REPUBLIC

16.1 Overview on the older persons homecare service in Czech Republic

The Risk of social exclusion of population over 65 years old in this country lower with respect to the other EU-

27 , the estimation of Eurostat 15/02/2011 is 11,7% , even if Czech Republic struggle with an overall ageing

population, the percentage of over 65 in 2012 was 16.2% [World Bank 2014] at it has been estimated to

increase at 20.2% in 2020 and 30.9% in 2050 [European Commission, 2009 Ageing Report].

The main reason of this is due to high percentage of informal care provided by relatives of old people. Even if

there are no systematic research on informal care for elderly in Czech Republic [Holmerovà, 2004] the

estimation of informal care providers is about 4-5 hundred of thousand persons [Sowa 2010] and the 80% of

care is provided by the family. The total volume of informal care provided was reported to be 7.6 million hours

per week, mainly provided in the form of household support (Hrkal et al., 2011).

For this reason the perception that people have about the homecare is almost a minor needs generally

perceived for severe disability [Nivel project 2012].

In Czech Republic, as well as in the majority of the other Eu country, Home-Care services are a combination of

health and social care to be provided in the social environment of the needy person. Netherless the definition,

there is a strong competition between medical care and social care that impairs the home-care infrastructure-

regions, so they do not have a dense network of home care.

Home care services are dived over 2 ministry and the Home-Care schemes are divided according to the type of

services: (ii) health services or health care which comes under the Ministry of Health and (ii) social services,

supervised by the Ministry of Labour and Social Affairs.

The Social Services Act 2006 tried to improve the coordination between the two systems, social-care and

health-care, by allowing cross-funding between the two system and flexible care allowance but this

coordination is still imperfect mainly due to the strong financial incentives for patients to remain in health-care

facilities, even unjustified. The flexible individual care allowance has also enabled some patients to pay for

care by family members or volunteers. (Alexa et al. 2015).

Unfortunately up to now results of such coordination are poor but are planned new law to support the

integration of services.

16.1.1 REGULATION

The regulation is not at national level but at regional or mixed national and municipal level. Unfortunately

there is an explicit policy document only for one type of home-care.

The compulsory health insurance (Act no. 48/ 1997 Col. on Public Health Insurance) funds the health care as

well as the provision of home nursing (including personal care) and rehabilitation at home. Nursing is intended

Deliverable 2.1


to care for persons after hospital or for chronical patients, and in general for qualified care provided by

professional nurse.

The ways of reimbursement and the cost limits are addressed in the List of Diagnostic and Therapeutic Acts –

Decree of the Ministry of Health Care 134/1998 Col.

The qualifications and responsibilities of the professional team members, for health care services, are

regulated (Acts nos. 95 and 96/2004 Col., and Decree of the Ministry of Health Care 424/2004 Col., on

Responsibilities of the Non-Medical Staff) as well as the required equipment of home care agencies (Decree

no. 49/1993 Col.), which stipulate for detailed material and technical equipment of the agencies, as well as for

the criteria of professional qualifications of the caregivers.

Instead the provision of long-term care, including home care, is covered by social care services based on tax

money and provided by municipalities.

The Law on Social Services (2006-2007) regulates the provision of home care, access to cash benefits for

individuals with limitation in ADL and different types of residential care.

The quality of social services is regulated by law (108/2006 Sb) and it is frequently checked by the

municipalities, so the care providers are obliged to develop internal standards over the compulsory

registration (social act 108/2006 Sb).

As briefly cited, health insurance is compulsory in the Czech Republic, in any case individuals are allowed to

choose their health insurance fund and to switch to a new fund every 12 months. Risk selection is not

permitted so insurance funds are obliged to accept any applicant.

16.1.2 HOME-CARE PROVIDED SERVICES

There are two types of care provided to the old persons home (Sowa, 2010): home care and home nursing

care.

Home care includes personal assistance services and community care in ADL, i.e. dressing, washing, shopping,

meals and transport.

Home nursing care, or Comprehensive Home Care, introduced in 1990, is a combination of home health and

assistance covering partially the outpatient care. It combines nursing and rehabilitation provided by the

consultancy of the doctor and the typical activities includes assistance in medicines, blood pressure measuring,

taking blood…

The practitioners more involved in home care and home nursing care are Nurses and Volunteers from private

or no-profit agency. It has been estimated that the 58% of homecare agency provides care during night and

weekends, the 22% during weekends and 20% in the afternoons (Sowa 2010).

There are severe regional disparities on the provided services, for examples rural regions have scarse

specialised care services and the cost of transportation of patients, to doctors or rehabilitation services, are

not always possible. The problem of unequal regional distribution of home care services and home care

agencies, within the lack of a unique vision of home-care (each of the ministries develops different measures

and policy) increase the difficulties in recruit specific policy on required competences for home care

practitioner, only for few figures that required s specific qualification.

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The services provided are, according to the definitions of project Nivel (Home Care across Europe, 2012):

- Domestic care

- ADL care

- Nursing care

- Provision of aids

- Support for informal caregivers

16.2 HHCP involved in older persons homecare service in Czech Republic:


The ministry of health accredits post graduate training programmes for nurses and paramedical personnel, but

in general no qualification for home-care services is required in Czech Republic only few domestic aid

professionals were qualified. The professions related to the home care that have particular qualification

requirement are (Jiří Horecký, 2010):

� Nurses: there are two types of nurses after the reform of 2007:

� Nurse Assistant. With a qualification of secondary school with a graduation, duty to take long-

term education and to gather a certain number of credits.

� Nurse. University degree is required to be a full nurse

� Social Workers, ergotherapists different possible qualification are required:

1. Secondary upper school (7 years) or higher education in the field.

2. Any university degree combined with 200 hours expert course.

3. Duty of long-term education in the extent of 24 hours a year.

� Employees in social services i.e. a worker who does the helping/basic social care lined by the Social

Services Act, that required a qualification of:

1. Basic education combined with 150 hours expert course.

2. Duty of long-term education in the extent of 24 hours a year.

Unfortunately there are no evidences about the specific activities performed at old person’s home by Social

Workers and Employees in social services, and for this reason it is difficult to found the required competences.

Similarly in the Czech Statistical yearbook (2008, Social Security) the home care service workers identified are

only (i) Professional nurses and (ii) Others the only other figure related to the activities performed at home are

the volunteers in agreement to what already described. No updated data are available from this source.

OECD- Health Statistics in 2015 identify the number of persons working in healthcare and social work in EU27.

Czech Republic has 339 300 healthcare practitioners in 2013, with respect to a population of around 10.5

million people. Of those practitioners, Nurses were 84 045, Physiotherapists 8 133 and Caring Personnel 24

261.

Following the definition of OECD Caring Personnel is an health care assistants in institutions and Home-based personal care workers (ISCO-08 5322 Practising caring personnel-personal care workers). It includes:

- Providers caring personnel working in health and social establishments. - Professions: auxiliary nurses, social care workers (direct activities and home care activities).

This means that the definition of Caring Personnel includes the Nurse Assistant and the Social Workers

previously introduced.

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NURSES

In this document we refer only to practitioner with University degree, classified according to the ISCO 08 with

codes 2221.

Nurses are mainly connected to the health care treatment. They are in charge to enhance and preserve health,

prevent and treat illnesses and conditions, support rehabilitation, and conduct palliative care where there is

no cure. They can be in charge of for the planning and management of the care of patients, working

autonomously or in teams with medical doctors and others in the practical application of preventive and

curative measures.

Among performed activities can be listed: professional qualified care; assistance with mobility;

assistance/supervision taking medication; assistance with personal hygiene; assistance dealing with

incontinence and/or skin care.

The Czech Republic neither signed or ratified the European Agreement on the Instruction and Education of

Nurses (CETS No.059). No specific information about Czech nurses competencies have been retrieved.

CARING PERSONNEL

In this document we refer only to practitioner without a University degree, classified according to the ISCO 08

with code 5322 and 5329, i.e. associated/auxiliary nurses and social workers.

To provide routine personal care and assistance with activities of daily living to persons who are in need of

such care due to effects of ageing, illness, injury, or other physical or mental condition in private homes and

other independent residential settings.

Caring personnel usually perform the following activities:

- assistance with eating and drinking (not the preparation of food);

- assistance dealing with incontinence and/or skin care (available if classed as part of home care);

- services offering companionship and social activities (some are on voluntary bases)

- assistance dealing with incontinence and/or skin care (available if classed as part of home care)

- services offering companionship and social activities (some are on voluntary bases)

- ergotherapy/occupational therapy, home adaptations and assistive devices.

No specific information about Czech caring personnel competencies have been retrieved.

VOLUNTEER

Any specific education is required for the home helpers. The activities they usually perform are:

- assistance with housework;

- help with the preparation of meals (including meals-on-wheels);

- transportation service;

- assistance with shopping (non in all the municipalities).

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16.2.1 References

Home care across Europe: Current structure and future challenges, Observatory Studies Series 27, WHO 2012,

ISBN 978 92890 02882, Nivel project.

http://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_personnel_statistics_-

_nursing_and_caring_professionals#Healthcare_personnel_.E2.80.94_nursing_professionals

World Bank 2014, http://www.worldbank.org/en/about/annual-report

European Commission, 2009 Ageing Report,

http://ec.europa.eu/economy_finance/publications/publication14992_en.pdf.

Holmerovà I, 2004, Eurofamcare National Background Report for the Czech Republic

Sowa Agnieszka 2010, “ The Long-Term Care System For the Elderly in the Czech Republic”, ANCIEN, ISBN 978-

94-6138-014-2, ENEPRI Research report No. 72.

Hrkal J, Bareš P, Daňková Š, Malečková R, Roubal T, Prošková E (2011). Analýza kapacit a sítě poskytovatelů

dlouhodobé péče [Analysis of capacities and networks for long-term care]. http://podporaprocesu.cz/wp-

content/uploads/2013/01/Analyza_kapacit.pdf.

Jan Alexa, Jana Votàpkovà, Ewout van Ginneken, Anne Spranger, Friedrich Writtenbecher, 2015, Czech

Republic – Health system review, Health Systems in Transition, Vol.17, no. 1, 2015

Jiří Horecký, 2010, Current situation in quality of residential care, Long-Term care in the Czech Republic

OECD- Health Statistics in 2015, http://www.oecd.org/els/health-systems/health-data.htm

Czech Statistical Office, Czech Statistical Yearbook 2008, Paragraph on Social Security , www.czo.cz

17 OLDER PERSONS HOMECARE IN DENMARK

17.1 Introduction to older persons homecare service in Denmark

Background information about dementia and home care services

In 1987, legislation more or less put a stop to the construction of conventional nursing homes for older people

and encouraged the development of independent specialised housing as well as home care services (Leeson,

2004). The current trend is to try to enable people to remain at home for as long as possible.

In Denmark, there is a classification system based on age with people over 60 forming the 3rd age group and

those over 80 the 4th age group. There are approximately 700,000 people over the age of 67 in Denmark (the

official retirement age). Of these, 172,000 receive long-term home-help and a further 7000 to 8000 people

receive temporary home-help. The vast majority of people receiving long-term home-help live in their own

homes. (Leeson, 2004). Jarden and Jarden (2002) estimate that there are about 189,000 people over 80 in

Denmark. A high percentage of the 4th age group receive home care services.

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Legislation relating to the provision of home care services

The Law on Social Assistance (1976) states that all communes must provide home help for the elderly. There is

no difference between the social protection offered to people suffering from dementia and that offered to

people who are dependent. The Social Service Legislation contains a few relevant references (taken from

Leeson, 2004):

According to paragraph 67a of the Social Services Legislation, local or regional authorities must determine

whether there are any relatives or other people who could represent the older person i.e. in an advocacy role.

Paragraph 71 part 60 states that local authorities should take into consideration the global situation of the

older person, including the overall network, when assessing the need for assistance. Relatives are expected to

participate in supporting the older person in the home. It is also suggested in part 96 of paragraph 71 that a

relative should assist in completing the various application forms and that everyone should be made aware of

this possibility.

Paragraph 72 deals with respite care. It states that local authorities are obliged to provide respite help to

spouses, parents or other close relatives caring for a physically or mentally disabled person.

Organisation and financing of home care services

The Danish healthcare system provides free and equal access to health care to all residents. It is funded

through general taxation but access to care is not dependent on a person’s financial status. Home care is

divided into two categories - long-term or temporary. Long-term home care is provided free of charge but

people may be asked to contribute towards the costs of temporary home care depending on the level of their

income (Jarden and Jarden, 2002).

According to the Ministry of Social Affairs (2002), a goal has been established to improve the organisation of

dementia care in order to ensure good coordination between local authority services and the provision of

treatment and care by the health service. Furthermore, the development of partnerships between the public

and voluntary sectors is emphasised, for example in areas such as respite care.

Since 1989, the Integrated Home Service has encouraged medical personnel to work in the home care sector

and social workers to work in medical institutions which permits a more flexible approach to home care

particularly in times of need. Since 1 July 1989, dependent elderly people have been entitled to permanent

and free home help.

Such assistance is offered following an assessment of the functional capacity of the person, of his or her needs

and on the basis of the service level determined by the local authority (Ministry of the Interior and

Health/Ministry of Social Affairs and Gender Equality, 2002).

In accordance with the Preventive Home Visits to the Ageing Law of July 1996, local authorities are obliged to

offer preventive home visits to all citizens over 75 years of age at least twice a year. The aim of these visits is

to encourage older people to use their own resources better and consequently allow them to preserve their

functional capacities as long as possible and also to be informed of the resources available from the

municipality. The elderly person can freely decide whether or not to accept the home visit and can decide

which subjects should be discussed.

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Since 1 July 2002, people receiving personal or practical services have been entitled to exchange the services

that they have been allocated for other services that they would prefer (Ministry of the Interior and

Health/Ministry of Social Affairs and Gender Equality, 2002). Since 1 January 2003, older people have had the

right to choose the providers of the personal and practical help and assistance to which they are entitled. Local

authorities therefore have to ensure that there are several service providers from which to choose. The older

person can then decide whether they would prefer the help with personal care and/or practical tasks to be

provided by a private person, the local authority or an authorised service provider. This means that a family

member could be chosen and would be paid by the local authority. This had been possible for a long time for

practical help but it has now been extended to encompass personal care (Jarden and Jarden, 2002).

Kinds of home care services available

Local authorities must provide nursing care in service users’ homes and offer help and assistance to maintain

physical and mental capacity. Such assistance should be provided in such a way that it encourages the

participation of the older people and helps them to manage alone thereby maintaining their autonomy for as

long as possible.

Home care services may include 24 hour assistance from a nurse, the provision of meals, the possibility to

adapt the home, day care centres, financial assistance and transport facilities. Sometimes this may also include

having an alarm system, maintaining the garden and clearing away snow. Certain services, such as minor repair

jobs, are not provided by the local authorities. Some voluntary associations offer assistance with such jobs.

Otherwise, the person can purchase the services from the private sector.

Meals may be delivered to the home by the local authorities at a subsidised rate. They are sometimes

prepared in residential homes and then distributed within the community. Day care centres also have meals

facilities.

Local authorities may also provide or finance services aimed at keeping people active or promoting their

health. Sometimes, such services are proposed and/or organised by voluntary associations but financed by the

local authorities. Such services might include sports activities, tuition/lectures and companionship for older

people who are lonely. In 1998, the Social Service Law introduced a yearly budget for the development and

expansion of voluntary services (Jarden and Jarden, 2002). DaneAge is an association, with a nationwide

network, which offers older people a wide range of activities and opportunities to socialise. It also provides

respite care for carers of people with dementia and trains volunteers so that they can provide such services in

people’s homes. These volunteers are of all ages and from all walks of life (Leeson, 2004). Respite care is also

offered by some nursing homes.

Consultation with people with dementia and carers

At the request of the Ministry of Social Affairs, 8 communes took part in a project based on home care for

elderly people with dementia and their families. Some of the communes sent out questionnaires to obtain

qualitative and quantitative information on the needs of the people with dementia and their carers.

The municipality of Vejle organised a project aimed at assessing users’ satisfaction with home care services,

getting a picture of how resources were used, establishing a common notion of what quality and quality

objectives are and drawing up a plan for the achievement of defined objectives. Users, employees and

politicians were all involved in the project. Users were involved in drawing up the questionnaires. There were

also group and individual interviews for which the elderly-talk-to-elderly method was used. It was felt that

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involvement of users and an elderly persons council was effective in motivating people. (This project was not

limited to people with dementia.) (EFILWC, 2002)

The situation on home care in Denmark

Healthcare and welfare is primarily governed by the Health Act and Social Services Act. Currently, there are

much focus on rehabilitation - the citizen must be able to fend for themselves as long as possible in their own

lives, as well as increased privatization and including free-choice scheme which allows the citizen to choose

between public or private homecare.

Generally, welfare and services in Denmark are under pressure due to longstanding savings and cut downs in

the municipalities. This may explain the increasing focus on rehabilitation because it wishes to prevent

admissions / readmissions and improve the work of early detection, so the cost of the elderly and infirm

citizens is held down.

17.2 HHCP involved in older persons homecare service in Denmark: roles

and competences

In Denmark can be identified two kinds of practical nurses/healthcareworkers in the homecare-sector: Social-

and health service assistants and Social- and health service helpers.

17.2.1 Social- and health service assistants

Social- and health service assistants works within a variety of workareas. Common to the worktasks is basic

healthcare- and nursing for citizens/patients. Social- and health service assistants work on a daily basis with

people with a need for basic healthcare and nursing eg. elderly citizens , patients in hospitals , mentally ill or

people with physical or mentally disability. Typical workplaces is within the municipal healthcare, in psychiatric

and in hospitals. Social- and health service assistants is authorized healthcarepersons. Today there is around

35.000 Social- and healthcare assistants in Denmark divided in regions and municipalities.

Social- and health service assistants perform basic nursing tasks in nursing homes, home care, psychiatry and

hospitals. The tasks may include personal care, performing delegated treatment, clinical nursing tasks,

medication, conversations, coordination of citizensprogress, rehabilitation, everyday-rehabilitation and other

activity with residents or patients.

Social- and health service assistants must also independently perform and organize rehabilitative tasks for

citizens. It can be related to activities that stimulate physical, intellectual and creative features. Social and

healthcare assistants may be employed in a variety of jobs, and can have many different jobs. The most

specific role is basic nursing, observation, identification of symptoms, rehabilitation, guidance, instruction and

information that are central tasks.

Social and health service assistants can take the role of supervisor of students in social- and healthcare

educational institutions.

Social and health assistants are employed under the Health Act.

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17.2.2 Social- and health service helper

Social- and health service helper perform a variety of tasks in care and practical help, but are not employed in

hospitals. A social- and health service helper is focusing on the well-being and care of the citizens. Social- and

health service helpers work on a daily basis typically with senior citizens who may be sick or influenced by old

age symptoms. Social- and health service helpers are also working with people with physical and mental

disabilities, and as a reliefperson in the care of people with severe disabilities. Social- and health service

helpers can work within all hours of the day.

Social- and health service helpers are employed under the Social Services Act.

Social- and health service helpers are providing care and practical help (cleaning, shopping and laundry) to

citizens who need support and help to maintain a normal daily life.

Social- and health service helpers have the skills to observe and recognize the symptoms of changing welfare

and health conditions. Social- and health service helpers must be able to explain and document these

observations. In this context, social- and health service helpers must be aware of their responsibilities and area

of competence. As a social- and health service helper you must also work with motivationtasks and enable

citizens to develop, maintain and preserve their resources (rehabilitating).

To ensure a coordinated and coherent assistance to the citizens social- and health service helpers have a lot of

contact with other professionals. Social- and health service helpers can take the role of supervisor of students

in social- and healthcare educational institutions.

17.2.3 References

European Foundation for the Improvement of Living and Working Conditions (EFILWC) (2002), Denmark –

http://www.eirpfpimd.ie/living /socpub_cstudies/de3.htm (accessed 31/5/2005)

Jarden and Jarden (2002), Social and health-care policy for the elderly in Denmark, Global Action on Aging,

http://www.globalaging.org/elderrights/world/densocialhealthcare.htm

Leeson, G.W. (2004), National Background Report for Denmark, EUROFAMCARE,http://www.uke.uni-

hamburg.de/extern/eurofamcare/documents/nabare_denmark_rc1_a4.pdf

Ministry of the Interior and Health & Ministry of Social Affairs and Gender Equality (2002), Questionnaire on

health and long-term care for the elderly, European Commission

http://europa.eu.int/comm/employment_social/social_protection/health_en.htm

Witsoe-Lund, L. and Ibenfeldt-Schultz, L., Le système d’aide et de soins aux personnes âgées atteintes de

démence sénile de type Alzheimer au Danemark. In Joël, M.-E. et Cozette, E. (2002), Prise en charge de la

maladie d’Alzheimer en Europe, Inserm

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18 OLDER PERSONS HOMECARE IN ESTONIA

18.1 Introduction to older persons homecare service in Estonia

In 1. January 2016, the population of Estonia was 1,311 800 (https://www.stat.ee/12808). Since 1990 the

number of births has been diminishing, the number of deaths has been growing and the population deceasing

(forecast for 20130 is 1,2 millions). The proportion of people aged 65-74 years has increased from 11.6% in

1990 to 17.1% in 2009 (Statistical Office of Estonia 2009). The population of very old persons (80 and over) is

expected to increase from 4,8 % (2013) to 7,2 % (2030). The life expectancies at bright are increasing from 71,6

years (2013) to 75,7 years (2030) by male and from 81,3 years (2013) to 84,1 years by female. In Estonia, there

is a high percentage of elderly people, particularly elderly single women living alone. An estimated 10% of the

residents of age over 65 need the geriatric evaluation team service (www.ubc.net_2966).

(http://europa.eu/epc/pdf/ageing_report_2015_en.pdf)

Estonia gained independence in 1918 and again in 1991. From 1991 to 2000, new principles of social security

were formed and new insurance systems were established. The Estonian health care system has seen a

number of reforms: changing from a centralized state-controlled system to a decentralized one and from a

state-funded system to one funded mainly through health insurance contributions. In 2001, the Ministry of

Social Affairs (MoSA) prepared the Nursing Care Master Plan 2015 in order to provide nursing care targets to

match the hospital targets set out in the Hospital Master Plan 2015. Reforms in the healthcare system are

closely linked to the social welfare system.

The Social Welfare Act (Sotsiaalhooldekande seadus RT I, 30.12.2015, 5:

https://www.riigiteataja.ee/akt/130122015005) covers the provision of home care services which are defined

as being services provided to persons in their homes which help them to cope in familiar surroundings. The Act

states that local government authorities shall establish a list of home care services and the conditions and

procedure for their provision as well name a carer to persons (the Social Welfare Act § 28/1). Rural

municipality governments and city governments shall establish opportunities for cheaper alimentation,

opportunities for interaction and hobbies, ensure the accessibility of information concerning services provided

and establish opportunities for the use of social services as well the security and independence of the elderly

living in social welfare institutions, respect for their private life and the opportunity to participate in decision-

making pertaining to their physical and social environment and future in order to assist the elderly (the Social

Welfare Act §27).

Long-term services comprise welfare and nursing services. The systems for health care and social welfare are

relatively separate. Funding for social welfare comes from local government budgets, the state budget, people

who voluntarily engage in social welfare and various other sources. The state budget provides local

governments with funds for social welfare but the local governments may also have to use their own budgets

for this purpose. Voluntary organizations, churches, foundations, commercial associations and non-profit

organizations can all provide social services.

People who are in need of services must contact their local government in order to organize for a social

worker to assess their needs and determine the kind of care they will receive (based on their needs and

financial situation). Elderly people may be offered a geriatric assessment (from 2004) and it consist of a single

assessment to determine clients’ needs and to provide them with suitable services covering health care,

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nursing care and welfare services. The geriatric assessment team is composed of a physician, a nurse and a

social worker and an international standardized tool is used for the assessment.

In case of needing assistance people can receive various care services according to the needs and available

resources. The providers of social services may charge beneficiaries or their families for their services. Children

and kinsfolk are legally obliged to take care of their elderly relatives. However, if they are unable to do so or if

an elderly person does not have any relatives, the Government must assume responsibility for their care.

Estonian Health Insurance Fond (HIF) covers the costs of the service in case of a referral letter from GP or

medical specialist. Medications used during home care service shall be paid by the patient.

In the Law on Social Welfare (Social Welfare Act RT I, 30.12.2015, 5:

https://www.riigiteataja.ee/akt/130122015005), home care services are defined as services provided to

persons in their homes which help them cope in familiar surroundings and it is stated that a list of domestic

services and the conditions and procedure for their provision shall be established by local government

authorities.

Welfare services are:

Home services – services offered to persons at home, helping them with coping in their usual environment;

excluding the care that requires physical contact. The local government is responsible for assuring long-term

aid to those living at home, making sure they have access to general public services. Home services are

household chores, procurement of food, pharmaceuticals, other necessities and firewood or other fuel,

information and assistance in administrative matters, etc.

Accommodation or housing service (including adaptation) – supplying facilities for 24 hour accommodation,

including rental of accommodation. Service providers are either a local government or a private company.

Services include making necessary adaptations for more comfortable mobility and security in the room.

Personal assistance service – helping persons with low coping ability to perform activities, helping them to

move around, in issues of personal hygiene, administrative matters at home and outside. Service is provided

by local government.

Day care in a welfare institution - supporting a person's or his/her family's coping capacity in institutions

where the person spends the day.

Long-term care in institution

Nursing services are regulated by Regulation of Ministry of Social Affairs („Iseseisvalt osutatavate õendusabi

tervishoiuteenuste loetelu“ 10.01.2002, nr 11, RTL 2002, 14, 178). In 2003 the Estonian Health Insurance Fund

started to cover expenses for long-term care, nursing care and some home care. There are follow services

offered at home:

• Home care (Koduhooldus) –for people of all ages in case of need some assistance at home

• Home nursing care nursing and welfare services to improve the clients' health and welfare, supporting

their livelihoods and homes in the community. Home nursing care is a part of open care (Avahooldus).

• Official or formal care (Ametlik ehk formaalne hooldus) – services provided to salaried employees

which support or supplement informal care (sometimes replace them).

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• Informal care (Mitteametlik ehk mitteformaalne hooldus) - care or basic nursing care of an elderly or

disabled family member or a relative in home conditions by relatives or family care of a person in a

suitable family where he/she is not a member of the family. Local governments offer supporting

services to help the carers and to pay compensation to cover the costs related to caring, which is not a

remuneration/salary.

Home care nurse service offers support to patient´s family and intimates who need counseling in nursing

activities. Home care is only available if the procedure needed does not require any special equipment. A

home care nurse has a special training in the field of providing in-home nursing services. The nurse draws a

caring plan according to patient´s needs and diagnosis. The plan gives guidelines for further activities:

bandaging, collecting analyzes, administrating medications, measuring blood pressure, bedsores treatment

and other. Nursing service is conducted in close collaboration with patient´s doctor and intimates and local

social worker or caregiver if indicated. Home care nursing is possible by following pre-conditions: patient’s

medical condition does not require hospital treatment, but requires nursing services; patient and his/her

family agree to the service and collaboration; home offers suitable conditions for undergoing the procedures;

patient and his/her intimates are emotionally supportive towards the service. A patient and a nurse sign a

contract, which gives the nurse rights to perform home care services at patient´s home.

(http://www.itk.ee/en/clinics/long-term-nursing-clinic/about-nursingclinic/long-term-nursing-center/home-

care-service.) Home care nurse, as well care worker and nurse (planner and organizer) work in home care

team. Active members in home care are home care nurse (EQF4) and care worker (EQF3). Nurses will

participate only as external experts by planning care plan. Older people will visits their doctors who will be

responsible in decisions and medicaments. (http://www.sm.ee/sites/default/files/content-

editors/eesmargid_ja_tegevused/Tervis/Tervishoiususteem/koduoenduse_tegevusjuhend.pdf).

There are over 200 municipalities in Estonia and many of them are very small. For this reason, it is impossible

for them all to offer a full range of services. Nevertheless, home care services are offered mostly in bigger

towns and only for persons who have got any relatives. Older persons or their families can hire themselves a

private carer (friend, voluntaries, student etc.). Access to the official home care services is quite difficult. There

are need to offer home nursing around Estonia 7 days per week and 24 hours. The average number of visits

per working day is 4 -6 clients but in country side maximum is 4 clients. The home care practitioners use the

most time for guidance and support of client (20 %), assistance in daily activities (17 %) and for caring and

nursing (15 %) as well for procedures (9 %). Example in capital of Estonia, Tallinn, the average number of visits

per month for one patient is 15; this allows one nurse to deal with 70-80 patients every year, making approx.

1320 visits annually (http://www.sm.ee/et/hooldaja-maaramine-koduhooldus).

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18.2 HHCP involved in older persons homecare service in Estonia: roles and competences

CARE WORKER (EQF3)




Household chores Knows practical principles of household and cleaning Knows living environment of elderly people Knows income security Knows nutrition and healthy diet

Has skills in household chores (cleaning, washing, taking care of clothes), procurement of food and shopping, other necessities and firewood or other fuel Notices a healthy diet and nutrition

Organizes domestic work Gives information and assistance in administrative matters, etc.

Support by outdoors moving and ability to function

Knows ageing changes and the resulting personal needs and restriction of operational capacity. Knows physiology and functions in general

Supports a person's by outdoors activities (by going to shop, bank etc. administrative matters)

Gives information and assistance in administrative matters, etc.

Personal care and activities in normal daily life

(1 -2 years education program) Knows principles of personal care Knows standards of Hygiene

Takes care in personal hygiene Assistances in daily activities Implements caring activities

Works by guidance of home care nurse and follows the caring plan

First aid and pharmaceuticals assistance

(1 -2 years education program) Knows basic anatomy and physiology, relevant disease patterns Knows nursing aids Knows how to act in emergency situations

Implements simple technical procedures Gives first aid for seizures, accidents and trauma. Defines the health status Resuscitates Assists nurse in nursing activities Procurements medicines

Works by guidance of home care nurse and follows the caring plan

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Communication Knows interpersonal skills and techniques of communication and principles of communication in different situations. Knows the Code of Ethics.

Supports client and his/her family Uses communication skills based on win-win (such as contact taking-holding-finishing, active listening, clear self-expression and assertiveness skills). Is able to prevent conflicts and/or resolve them constructively. Makes work-related choices and decisions and solves problems. Communicates with customers and colleagues in a client-centered way. Can act as a team-member and collaborate with other professionals and service providers.

Guides the client and his/her family Understands and responds to customer messages based on the specific client. Operates in a client-centered way while keeping the role of the service provider. Acts by ethical principles. Works as a team-member while respecting the principles of the work-group

HOME CARE NURSE/CARE WORKER (EQF4)




Household chores Knows practical principles of household and cleaning

Has skills in household chores (cleaning, washing, taking care of

Organizes domestic work Gives information and assistance

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Knows living environment of elderly people Knows income security Knows nutrition and healthy diet

clothes), procurement of food and shopping, other necessities and firewood or other fuel Notices a healthy diet and nutrition Organises safety living environments

in administrative matters, etc. Takes care of the environment, electrical and fire safety and, where necessary, knows how to protect himself/herself and the clients. Knows how to prevent accidents and injuries at work.

Support ability to function and activating client

Knows ageing changes and the resulting personal needs and restriction of operational capacity. Knows physiology and functions in general. Knows physical and psychosocial changes of ageing


Has skills to utilize the clients' capacity and activate it, can create a cozy, aesthetical, and simulative environment (music, dancing, gymnastics, games, walking, memory, memory exercises, literary activities like reading etc., crafts, baking, everyday activities etc.).

Can assess, plan, and act with clients with different operational capacity in groups and individually.

Gives information and assistance in administrative matters, etc. Uses activating methods in the client work while considering other workers and the agenda.

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Personal care and activities in normal daily life

Knows principles of personal care Knows standards of Hygiene Knows the most common diseases of different organ systems, influencing factors, and the main principles of care. Knows the care principles for a dying client. Takes advantage of the information on the work of the elderly, the physical and psychological illnesses and their treatment: the care of the mouth, skin, and feet; methods of physical activity and activity of physiotherapy; eating habits; nutrition and diabetes, pain treatments; memory disorders and their treatment; accident risks in the elderly first aid

Helps and guides in hygiene and dressing, considering clients' special problems (the care of the mouth, skin, and feet) Assistances in daily activities (supports continence, eating and drinking, respiration etc.) Implements caring activities Notices the client's ability to cope, his/her habits, beliefs and life experiences, and notices the potential social problems as well as the needs of care services.

Is able to identify changes in the elderly client's health status and act accordingly. Is able to assist clients' living arrangements(care and nursing activities) Guides clients to use facilities and terotechnology

Works by guidance of home care nurse and follows the caring plan. With the support of the working group, draws / develops and updates the plan together with the client and their representative and implements and evaluates it. Is able to care for elderly clients while taking into account their life experience and the needs at the institution and in home care. Can give first aid and resuscitation.

First aid and pharmaceuticals assistance

Knows basic anatomy and physiology, relevant disease patterns Knows nursing aids Knows how to act in emergency situations Knows the main principles of

Implements simple technical procedures Gives first aid for seizures, accidents and trauma. Defines the health status Resuscitates Assists nurse in nursing activities

Works by guidance of home care nurse and follows the caring plan. With the support of the working group, draws / develops and updates the plan together with the client and their representative and implements and evaluates it.

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medical care. Knows the effects and side-effects of drugs, the most typical embedding, and the misuse symptoms

Procurements medicines

Communication Knows interpersonal skills and techniques of communication and principles of communication in different situations. Knows the Code of Ethics, care-work regulating maintenance manuals, and legislative acts. Knows how to use maintenance manuals and legislative acts in elderly-work.

Knows the management of social services.

Supports client and his/her family Uses communication skills based on win-win (such as contact taking-holding-finishing, active listening, clear self-expression and assertiveness skills). Is able to prevent conflicts and/or resolve them constructively. Makes work-related choices and decisions and solves problems. Communicates with customers and colleagues in a client-centered way. Can act as a team-member and collaborate with other professionals and service providers.

Guides the client and his/her family, motivates and activates clients Understands and responds to customer messages based on the specific client. Operates in a client-centered way while keeping the role of the service provider. Acts by ethical principles. Works as a team-member while respecting the principles of the work-group

Working in team Knows the main principles of teamwork and how to use a

Organises teamwork Supports colleagues, solves

Organises, advices and leads team

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variety of teams to support people.

problems Chooses a suitable communication form Delegates work

Works with elderly, children as well with people of special needs

18.2.1 References

European Observatory on Health Systems and Policies, Health Care Systems in Transition, HiT Summary for Estonia, WHO Regional Office for Europe, http://www.who.dk/document/e85516sum.pdf#search='HiT%20summary%20AND%20Estonia' Kõre, J. (2005), Possibilities for integration of health and welfare services in Estonia in liberal political and economical circumstances, http://www.socialeurope.com/pdfs/Venice/presentations/kore.pdf# Merle Malvet, Pille Liimal and Kaja Vaabel (2005), Social care and welfare for the elderly and social services, http://www.parnu.ee/raulpage/welfa97.html#elderly Paat, Gerli and Merilain, Merle (2010). ISBN 978-94-6138-017-3 (http://www.ancien-longtermcare.eu/node/27) Social Welfare Act of 1995, http://www.legaltext.ee/text/en/X1043K6.htm Social Welfare Ministry (2005), Health and Long-term Care in Estonia: National report, April 2005, unpublished report. Social Welfare Ministry (2005), Developmental plan of Estonia’s nursing care network from 2004 to 2015, (http://www.sm.ee for Estonian version). Valdja, U. (2005), WHHO-Compendium Text (extract on the Estonia), http://www.nahc.org/WHHO/WHHOcomptext.html

http://www.alzheimer-europe.org/Policy-in-Practice2/Country-comparisons/Home-care/Estonia http://www.itk.ee/en/clinics/long-term-nursing-clinic/about-nursingclinic/long-term-nursing-center/home-care-service http://www.kutsekoda.ee/et/kutseregister/kutsestandardid/10558953 http://kutsekoda.ee/et/kutseregister/kutsestandardid/10559015/pdf/hooldustootaja-tase-4.10.et.pdf www.ubc.net_2966

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19 OLDER PERSONS HOMECARE IN FRANCE

19.1 Introduction to older persons homecare service in France

The population of France is 65.3 million, and over a quarter is aged 60 or older. By 2030, it is estimated that

those over 60 will number some 20 million. The sharpest growth will be in the group aged 75 and above, which

is expected to increase threefold. The 85+ group will be four times larger. These demographic changes will

increase demand for elderly care facilities. (Morozova, 2015)

Traditionally, it is natural among the French for senior relatives to be cared by their families. In accordance

with the law, children are required to provide for their ageing parents. This, in particular, is the reason why old

people's homes and retirement homes are less common in France than in other Western countries. Recently,

however, this has gradually begun to change.

A survey conducted by one of the country's leading sociological research centres, IPSOS, confirms that 90

percent of people aged 50 or older would prefer to live in their own homes as long as possible. A quarter

of those over 85, though, are already in some form of assisted living, which amounts to around 450,000

people. In reality, it is not rare to see 85+ people in France: it has always been on the list of countries with

the longest life expectancies. France invests more than most other European countries in health care, and the

country's senior population benefits from this. The WHO ranked France's health care system as the best in the

world depending on the fact that the French agree to "pay more to get more."

Furthermore, the data indicate that care provided exclusively by household members constituted only one-

third of the cases in France, that means that same household caregivers were more often than not reinforced

by other sources of caregiving, whether formal, informal or both. The report shows that of all the French

respondents who received any care, one-third received only informal care, about 40 percent received both

formal and informal care, and one-quarter received only formal care.

Historically, healthcare and social care services have been structured around large national non-profit

associations of patients and their families. In France, these associations are grouped by type of care depending

on the target users (people with motor disabilities, intellectual disabilities, sensory disabilities or mental health

problems, senior care).

As is the case for all private companies in France, all structures delivering home-care services as well as

residential care services (except public employers) are controlled both by Labour Inspection (a government

administration verifying that the labour legislation is adhered to) and the DGCCRF (General Director for Fair

Trading, Consumer Affairs and Fraud Control, a government organization in charge of verifying the quality of

goods and services provided to the public).

There are many companies involved in home care. According to the National Agency for Personal Services

(Agence Nationale des Services à la Personne), 11,600 different companies were providing care at the home of

elderly people or people with disabilities in 2012. Some of these structures are part of one of the national

federations of home-care organizations.

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The companies sending workers to the homes of people with disabilities (Sector 8810A – aide à domicile in the

2010 labour survey) are quite varied, but most have an associative structure. As a whole, 54% of the workers

in this sector are employed by non-profit organizations (Association Loi De 1901), 11% work for a private

company, 7% are employed by the public sector (mainly local authorities), 3% are employed directly by the

households they work for and 2% are self-employed. Those employed either by an NGO or private company

represent 22% of workers, but the employers’ legal status cannot be identified more precisely in the survey. In

this survey, there were no employees in the home-care sector working for a cooperative company.

A recent survey shows that French elderly people prefer to stay at home rather than in a residential care

setting (Baromètre Prévoyance Dépendance 2011 TNS SOFRES). The fact that home care is cheaper than

residential care has not greatly influenced the debate in France.

In France, the sector of community-based home care matches a range of different issues, such as

• home hospital services;

• home nursing services;

• helping people with disabilities get up, washed and dressed in the morning;

• household cleaning, cooking and shopping;

• helping them go for walks and attend leisure activities;

• assisting people with disabilities to travel

Recruitment intentions in home care services (home helpers – aide à domicile and aide-ménagère) were

particularly high in 2012, with more than 50,000 forecasted recruitments; that means around one-third of the

recruitments in the care sector.

The recruitment of home care workers for elderly people is commonly directly managed by the household.

Around 57% of the 891 million hours of care provided in personal services in 2010 was carried out by workers

directly recruited by households (Ould Younes, 2012).

Since 2005 Borloo plan has two goals: developing more jobs in the care sector and responding to social needs

by establishing a long list of activities, mainly related to traditional home care for older people, that can

provide tax reductions.

In 2010, 1.46 million people were working in community care, including one million employed directly by

households.

In January 2006 the Universal Service Employment Cheque (Chèque Emploi Service Universel, CESU) was

introduced, with the main objectives to promote the development of personal services, to reduce the use of

undeclared staff in the domestic sector and to ease the recruitment and employment of home care personnel.

The CESU was introduced to simplify the administrative work and to secure the payment of wages and social

contributions for domestic workers. The cheques can be used for paying staff, who are directly recruited or for

paying an organization that provides the domestic worker.

Professionals involved in home care in France are:

• employé à domicile/aide à domicile (home helper/home aid) (level 1), providing mainly IADL-related tasks; possibly having attained an ‘Assistant de Vie Familiale’ diploma.

• auxiliaire de vie sociale (home care assistant) (AVS) (level 2/3); additionally performing personal care services (same tasks as a nurse assistant, but not to people with disabilities linked to chronic illness).

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• aide soignant (nurse assistant), providing help with IADL, and allowed to perform personal care but under nurse’s supervision, two years training leading to national diploma.

Services designed to maintain or restore individuals’ autonomy (primarily ADL (Activities of Daily Living) and

IADL (Instrumental Activities of Daily Living) services) are legally defined at the state level. Education and

training courses for any type of home-workers are defined jointly by the labour and health and social ministry

and candidate may apply for at least 6 different types of qualifications, the most frequent being the AVS

diploma. Still despite policies aiming at enhanced training programmes for home help and care sector, 75% of

people working in SAD had no professional qualifications in 2005. The control on staff’s professional expertise

is higher on non-profit agencies than on intermediate agencies (which only provide home workers to old

persons).

Education

The education system for the care sector is mostly structured around two main trades of social workers:

- social assistants, mainly dedicated to providing information to people in need of care services

- specialized educators, directly in charge of delivering help and services.

Apart from social workers, home-care assistants (Auxiliaires de Vie Sociale) are low-skilled workers with low

salaries and poor-quality, often part-time, jobs with lots of travelling from one client to another. The

development of VAE (Professional Validation by Experience) is meant to improve the qualification level of

these professionals, but the various obstacles encountered lead to a low success rate – around 2% of

candidates acquire this certification.

In a context of decreasing public resources, the care sector has to accept the need to make services more

professional, ensure the quality of employment in the sector and increase the range of services to meet a

broad, increasingly diversified range of demands.

There is a discrepancy in the demand for improving the qualifications of the staff in this sector and the

reduction of public subsidies to pay for the services. People with disabilities and older people have important

needs, but their ability to pay more for the care they receive is limited.

Financing

Since 2002, benefits for seniors needing care have been provided through the so-called APA system (Allocation

personnalisée à l'autonomie). The funds for these benefits originate from local councils and the newly created

agency CNSA (Caisse Nationale de Solidarité pour l'Autonomie). The CNSA does not finance itself via tax

credits. Rather it gathers funds from an extra working day of employees and by taking an additional 0.3

percent tax from employers, also claiming assistance from the existing healthcare budgeting system.

The benefits are primarily intended for care for the elderly, but they also aim to give seniors a chance

to maintain their independence for as long as possible. (Morozova, 2015)

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19.2 HHCP involved in older persons homecare service in France: roles and competences

EMPLOYÉ À DOMICILE/AIDE À DOMICILE (HOME HELPERS/HOME AIDS) (level 1); provide mainly IADL (Instrumental Activities of Daily Living) related tasks;

possibly having attained an ‘Assistant de Vie Familiale’ diploma. Home-helpers are intended to provide assistance with everyday tasks to people aged 60 or more

to enable them to carry on living in their own homes. The aim of home nursing care services is to prevent, postpone or shorten stays in hospital or residential care

institutions.

The Elderly Dependency Act of 20 July 2001 introduced the “allocation personalisée d’autonomie” (individual attendance allowance) known as APA. This

allowance, paid to dependent people over the age of 60, is intended to cover the costs of any assistance they need due to the loss of their ability to care for

themselves. They must also have their main residence in France and be dependent according to the AGGIR scale (Autonomie Gérontologique – Groupes Iso-

Ressources).

According to article L113-1 of the “Code de l’Action Sociale et des Familles”, any person over 65 without sufficient resources may benefit either from home help or

a place in a private home or establishment. This home help may take the form of a payment or actual assistance with household tasks.

Home help is partly financed by retirement schemes (depending on the income of the person receiving the service) and partly by social welfare benefits provided

by the “département”. Certain services, such as meals-on-wheels and house alarm systems, are often financed by regional governments and recipients may have

to contribute towards costs. Home nursing care services and other paramedical services, on the other hand, are fully financed by the healthcare system. Home

care services for elderly people are mainly provided by private non-profit making associations and by municipalities. Many services are provided by volunteers and

are therefore cost-free.

People who need assistance (but to a lesser extent than that needed by people who are entitled to the individual attendance allowance) receive special

allowances or increased benefits to pay for services from third parties (European Commission, 2002).

The Law 2005-841 of 26 July 2005 on Personal Services and Social Cohesion introduced the “cheque emploi service universel” (CESU), which came into force on 1

January 2006. This replaces the “cheque emploi service” and the “titre emploi service”. CESUs can be purchased by individuals and used to pay directly for services

required by an individual, including home help for elderly or disabled people, ironing, gardening and general housework. They can be for a predetermined amount

or for an amount to be decided by the purchaser. They can also be co-financed by employers much in the same way as luncheon vouchers or holiday vouchers.

Employers are entitled to a tax deduction (credit d’impôt) of 25% of their costs. It is also possible for other organisations to finance the CESU such as pension funds

and insurance companies (webpublic.ac-dijon, 2005).

The cheques can be purchased from any bank in collaboration with the national office for the collection of social contributions. People or organisations providing

the services simply deposit the cheques into a bank account.

The APA can take the form of services or cash and is paid irrespective of whether the person lives at home or in an institution. The allowance is for human and

technical assistance, not the provision of care, which would be covered by health insurances. People in receipt of the APA can choose whether to pay for a service

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or to pay for a private person to provide the service (with the exception of spouses). A private person who is paid to provide a service must declare this as a salary.

As of 1 January 2006, people with a monthly income of less than EUR 658.4 are not obliged to contribute towards the costs of the APA. People with an income

higher than EUR 2,622.34 have to make a contribution of 90% of the costs. Those with incomes between these two amounts have to contribute progressively

towards costs.

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

ENVIRONMENTAL

MONITORING

Knowledge of the basics of home environment

safety

Reporting environmental risks (to whom,

how, with what times)

Evaluating safety risks in home

environment

Knowledge of the basics of hygiene in home

environment (cleaning, food etc.)

Reporting hygiene risks (to whom, how, with

what times)

Evaluating hygiene risks in home

environment

Taking actions to reduce the risks

HEALTH MONITORING Knowledge of the main indicators of

- physical risk conditions - mental health conditions

Reporting health risks (to whom, how, with what times)

Evaluating (mental and physical) health risks in home environment

Taking actions to reduce the risks

EQUIPE WORKING

Knowledge of the network of services which can support older adults at local level

Addressing older adults to the main existing services which can improve their quality of life

Evaluating the usefulness/necessity of activating a service

Activating formal and informal support to stimulate active and healthy lifestyle

Building a network around the older adult in collaboration with medical social workers, neighbors and volunteers


Knowledge of the basics about the administrative practices related to aging

Supporting older adults in filling in tax return form and other administrative practices

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management Use of information technology tools

ACTIVITIES OF DAILY LIVING SUPPORT

Knowledge of the basics of domestic economy

Going shopping

Evaluating the purchase of the proper food according to economic availability and nutritional requirements Knowledge of the basics of nutrition principles

Knowledge of the basics of physical and mental conditions of older adults

Accompanying older adult in the proper way when going out

Knowledge of the basics of socializing patterns Promoting social activities Promoting older adults participation in social activities relying on their network and/or expanding it

AUXILIAIRE DE VIE SOCIALE (AVS) (HOME CARE ASSISTANT) (level 2/3); additionally performing personal care services (same tasks as a nursing assistant, but not

to people with disabilities linked to chronic illness).

In March 2002, a national qualification called the Diplôme d’Etat d’auxiliaire de vie sociale (DEAVS) was introduced by decree in France. It specifically aims

at improving the qualification levels of staff in the care service sector and at increasing the basic pay levels for qualified staff in the domestic care sector.

The training is based on the idea that care service workers will be expected to carry out new tasks in the future, including taking care of increasingly fragile

groups. Stress is placed on the ethical and deontological aspects of their jobs, as well as on the importance of working as part of a ‘care team’. The DEAVS

is also intended to help care service workers access other types of training.

The following principles must be respected when working as an AVS:

1. respect for the dignity, integrity, private life, privacy and safety of the person receiving care;

2. freedom of choice among the services offered;

3. customised provision of care and assistance that promotes development, independence and integration, and is adapted to age and needs;

4. confidentiality of information on the person receiving care;

5. access to information concerning the person receiving care;

6. information on the basic rights, the legal and contractual protection offered, as well as the possible legal remedies; and

7. participation in setting-up and implementing the plans to receive and assist the person.

Deliverable 2.1


ROLE

(SET OF

ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be


Knowledge of home environment safety Reporting environmental risks (to whom, how, with what times)

Evaluating safety risks in home environment

Knowledge of hygiene in home environment (cleaning, food etc.)

Reporting hygiene risks (to whom, how, with what times)

Evaluating hygiene risks in home environment

Taking action to reduce the risks

HEALTH

MONITORING

Knowledge of the main indicators of risk conditions for physical and mental health Knowledge of the ageing process

Reporting health risks (to whom, how, with what times)

Evaluating health (mental and physical) risks and difficulties in home environment Taking action to reduce the risks

Stimulating autonomous management of daily activities

Identifying the daily activities that can be autonomously performed by the older adults

EQUIPE WORKING Knowledge of the network of services which can support older adults at local level

Addressing the older adults to the main services that can improve their quality of life

Evaluating the usefulness/ necessity of activating a service

Knowledge of the communication strategies Activating formal and informal support to stimulate active and healthy lifestyle

Creating the conditions to build a network around the older adult in collaboration with the GP, social workers, neighbours and volunteers


Knowledge of the basics about the administrative practices related to ageing management

Supporting older adults in compiling fiscal practices and other administrative practices

ACTIVITIES OF DAILY LIVING

Knowledge of the basics of nutritional principles Going shopping Evaluating the proper food to be bought on the basis of economic

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SUPPORT availability and food requirements

Knowledge of the basics of domestic economy Providing personal hygiene and personal care in general

Assessing the requirements and the abilities of the older adults


Supporting the older adult in the proper way when going out of home

Knowledge of the basics of social interaction Supporting social interaction

Promoting older adults social participation relying on his/her network and/or expanding it

AIDE SOIGNANT (Nurses’ aid, Nursing assistant, Care assistant, Healthcare worker). They are trained professionals, who support the nursing staff in hospitals,

long-term care facilities, rehabilitation clinics, in doctor’s offices and in home care in providing basic care for patients under nurse’s supervision. The job can

require ability to lift patients, great communication skills, and tolerance for clean up and care of patients who cannot fully care for themselves. Most nursing

assistants, who may also be called healthcare workers, undergo training through programs offered by colleges, medical or technical schools, and through

organizations like the Red Cross. Training is usually completed within a few weeks to a few months, depending upon the individual program, and classes are

frequently taught by registered nurses (RNs). Most nursing assistant jobs require certification, which may be gained through participating in a class and passing

examinations at the end.

The certified nursing assistants assist in the basic human needs of the healthcare profession. They may help to bathe patients, feed them, change diapers or beds,

empty bedpans, and help patients to bathroom or toileting facilities. They are also trained to take vital signs, which are measurements of pulse, blood pressure,

and respiration, and are responsible for charting vital signs several times during each shift. The nursing assistant also needs to be fully aware of any significant

change in a patient’s condition, and report it to the nursing staff.

In facilities where patients are hospitalized for long periods of time, it is usually the nursing assistant, sometimes with the help of hospital orderlies, who helps

patients turn over every couple of hours so they don’t develop bedsores. A nursing assistant may be the first responder when a patient calls for help, and the job

can require some physical strength and knowledge of safe lifting tactics when patients who are ill or recovering need to get up to walk around, change their

clothing, or get to the bathroom.

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Some nursing assistants may additionally support patients by helping them with prescribed physical or respiratory therapy exercises. In long term care facilities,

nursing assistants can be trained to help exercise patients who are paralyzed or in a coma. These health care workers may also work with patients in home care

settings, and may be the primary caretakers for patients recovering from conditions or who have long term disabling conditions.

ROLE

(SET OF

ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be


Knowledge of environment safety conditions Reporting environmental risks Evaluating safety requirements in home environment

Knowledge of hygiene factors (cleaning, food etc.)

Reporting hygiene risks Evaluating hygiene requirements

Taking action to reduce the risks

HEALTH

MONITORING

Knowledge of the main vital signs of people with disabilities linked to chronic illness Knowledge of the ageing process

Reporting changes in vital signs and patients’ conditions

Evaluating health (mental and physical) conditions and difficulties and changes in patients with disabilities linked to chronic illness Taking action to reduce risks

depending on bad vital signs

Stimulating autonomous management of daily activities

Identifying the activities that can be autonomously performed by the older adults

EQUIPE WORKING Knowledge of the local network of services which can support older adults

Addressing the older adults to the main services that can improve their quality of life

Evaluating the usefulness/ necessity of activating a service

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Knowledge of communication strategies Activating formal and informal support to stimulate active and healthy lifestyle

Collaborating with parents, GPs, social workers, neighbours and volunteers


Knowledge of the sanitary documentation related to ageing management

Supporting older adults in compiling sanitary documents and other administrative practices

ACTIVITIES OF DAILY LIVING

SUPPORT

Knowledge of the basics of nutritional principles Helping with feeding Evaluating the proper food to be bought on the basis of economic availability and food requirements

Knowledge of the basics of domestic economy Providing personal hygiene and personal care in general

Assessing the requirements and the abilities of the older adults


Supporting paralyzed and mentally and physically disabled older adults

Knowledge of the dynamics of social interaction Supporting social interaction

Promoting older adults social participation in social activities

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20 OLDER PERSONS HOMECARE IN GERMANY

20.1 Overview on the older persons homecare service in Germany

In January 2016, the population of Germany was 81 269 958. In 2015 the natural increase was negative but

due to external migration the population increased by 251 712.13. The population is expected to decrease to

74,512,858 until 205014. The population of very old persons (80+) is expected to increase from 5.4% to 13.4%.

The life expectancies for men and women at age 65 are increasing from 17.4/20.6 years (EU-27: 17.2/20.7) in

2010 to 22.4/25.4 years (EU-27: 22.4/25.6) in 206015. (Table 34)

Table 34: Background statistics of Germany (7-103)

There was 2,5 million people in need of care in Germany in 2013. 70 % of them (approximately 1,8 million) attended at home and 30 % (0,75 million) will stay in residential care homes for older people. From total 1,8 million people attended at home 47 % were cared by relatives and just 23 % in cooperation via ambulant care

13

http://countrymeters.info/en/Germany 14

http://www.worldometers.info/world-population/germany-population/ 15

ec.europa.eu/health/ageing/docs/ev_20140618_co04_en. 2014: 95.

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services. There was 12 300 ambulant care services with 300000 employees and 12349 home care providers.16 In home care, 63% of providers were private-for-profit, 36% private-not-for-profit and 1% public17. Estimates of the number of LTC dependent older persons in 2030 ranges from 3.17 to 3.37 million to around 4.4 million to 205018. The home care is regulated by following laws and regulations: The long-term care insurance law (SGB XI) offers a general regulation of quality management and quality assurance. Medical Service of the Health Insurance Institutions in in charge on the local or regional level by controlling of the quality rules and monitoring according to a treaty that has been agreed upon by all partners involved: the LTCI-institutions, representatives of care providers on the federal level, and finally, regional providers of social subsidy.19 Germany is one of the few countries what offer social protection for LTC. The social and private long-term care insurance (LTCI, 1995) is a compulsory insurance to cover a portion of long-term care nursing costs. All persons insured by social health insurance funds are automatically assigned by LTCI funds and are insured by private health insurance companies to a private LTCI.20 The new Pflege-Weiterentwicklungsgesetz (care extension law) introduces a gradual increase of benefits for home care. The Act to Reorient the Long-term Care Insurance 2012 ("Pflege-Neuausrichtungs-Gesetz" - PNG), improved a number of benefits of respite care and short-term residential care for persons receiving care allowance. The PNG strengthened care allowance and home care by raising supplementary benefits for people with dementia or rather and introducing “domestic support” (for example to communication, keeping up an adequate day structure or activities for maintaining social contacts in or near the domestic environment) as a new category of home care in kind.21 Legislation to strengthen the Long-term care system ("Pflegestärkungsgesetze") 2014 – 2015, will implement major elements of strengthening the long-term care insurance as envisaged in the Coalition Agreement.22 There are three different arrangements receiving a recipient LTC23: care allowance (informal care) giving at home by close relative; home care (in kind) - a professional care provider (paid by LTCI) visits the recipient regularly at home residential care - either short-term or long-term stay in a nursing home. The LTCI distinguishes between three levels of increasingly severe care needs: Level I: extensive care of at least 90 minutes per day; Level II (severe care): need of at least 180 minutes of care per day; Level III (most severe care): need at least 300 minutes of care per day. Medical Review Board of the Statutory Health Insurance Funds (MDK) for the social LTCI and an equivalent body for the private LTCI will assess the need for care formally. People with dementia, mental handicaps or comparable mental-health problems can receive additional support, regardless of the care level assessed. The beneficiary is supposed to be in need for care at least for six months. There are different prices of services on different level and, thus, the person in need of care has to bear the difference.24 Care coordination has for long been a major issue in LTC provision: every person in need of care obtained a legal claim to help and support through a long-term care counselor.

16

Nowack – Boldajipour, 2013. 17

ec.europa.eu/health/ageing/docs/ev_20140618_co04_en. 2014: 96. 18

ec.europa.eu/health/ageing/docs/ev_20140618_co04_en. 2014: 95. 19 http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf, 113. 20


ec.europa.eu/health/ageing/docs/ev_20140618_co04_en. 2014: 99–100. 22

ec.europa.eu/health/ageing/docs/ev_20140618_co04_en. 2014: 100–101. 23


ec.europa.eu/health/ageing/docs/ev_20140618_co04_en. 2014: 96.

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The attractiveness of the job of a HHCP is discussed broadly. There is the current and expected lack of qualified nurses and difficulties in finding qualified personnel in Germany. Immigration of qualified nurses from outside Europe is promoted. The government is working on new regulations for the three-year vocational training for nurses and nursing courses are expected to be introduced on an academic level. There is planned to merge three separate vocational educations (nurses for the elderly, nurses for children and nurses for acute-care of adults) in one general vocational training for nurses in order to enhance attractiveness and to broaden job perspectives.25 The geriatric infrastructure within the health care sector is still not well developed. Many long-term care facilities provide services of low quality. Family care was and is very important in Germany so also nowadays many elderly people are expecting to be cared for by their children, if care should become necessary. Currently, the majority of people in need of care receive either a care allowance or home care in kind, from family members, either spouses or children, between the ages of 50 to 65 years. The following professions belong to staff members in the home care agencies:26 • 33% are fully qualified nurses • 19% are fully qualified nurses for the aged (Altenpfleger) • 4.3% are aids of the fully qualified nurses • 2.9% are aids of the fully qualified nurses for the aged. The remaining staff represents different professions such as family care and social work, with 6.4% in vocational training. Mostly formal home care workers are so called nurse/carer for older people ‘Altenpfleger’ (EQF4) and careworker for older people ‘Altenpflegehelfer’ (EQF3). There is clear specialist deficiency in home care:

- right now there needed already more specialists/ skilled workers - until 2030 need up to 500.000 additional care workers - the number of persons in need of care will increase up to 50% or more (Quelle: Pflegereport 2030 der

Bertelsmann-Stiftung) - the number of young professionals decreases - lack of future senior/executive staff

Levels of home care staff in Germany27:

• Level 1 takes responsibility for delegated daily routine attendance • Level 2 lower than Assistance (for example Services under instruction) takes responsibility for

delegated personal assistance • Level 3 Assistance of the skilled worker takes responsibility for delegated tasks in care • Level 4 skilled worker takes responsibility for controlling individual care processes • Level 5 takes responsibility for groups of clients with special needs • Level 6 takes responsibility for groups of clients with complex tasks, and team leader • Level 7 takes responsibility for leading the institution • Level 8 takes responsibility for control of scientific functions

The regulations and procedures of vocational elderly care training (Altenpflegehilfe) vary in the individual German states. There was implementing of the reform in Germany merging of nursing education and training for geriatric care to a generalized care training, called nurses/health care professionals (Gesundheits- und Krankenpfleger). The new nurse/health care professional generalised people with receipt of unemployment benefit (SGB II/III) for exapmple immigrants without qualifikation and apprentices in initial vocational training from lower secondary schools who are interested in care.28

25

ec.europa.eu/health/ageing/docs/ev_20140618_co04_en. 2014: 98. 26 http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf, 115. 27

Nowack – Boldajipour, 2013. 28

Nowack – Boldajipour, 2013.

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The reform of education to caring professions was needed because

- the requirements of the qualification changes (multimorbidity, very old people etc.); - differentiation according to age groups is not anymore the current state of the nursing science; - it was necessary to raise the attractiveness of the qualification.

The new reform of vocational care training, over 3 years ,with access from intermediate secondary school (MSA) and new academic care training over 4 years in university.

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20.2 HHCP involved in older persons homecare service in Germany: roles and competences

CARE WORKER Altenpflegehelfer (EQF3)

ROLE (SET OF ACTIVITIES) KNOWLEDGE know what - theoretical


SKILLS know how to do - SKILLS as

cognitive

COMPETENCIES

know how to be

HOUSEHOLD CHORES Knows practical principles of household and cleaning Knows living environment of elderly people Knows income security Knows nutrition and healthy diet

Has skills in household chores (cleaning, washing, taking care of clothes), procurement of food and shopping, other necessities and firewood or other fuel Notices a healthy diet and nutrition

Organizes domestic work Cooks Gives information and assistance in administrative matters, etc.

SUPPORT BY OUTDOORS MOVING AND ABILITY TO FUNCTION

Knows ageing changes and the resulting personal needs and restriction of operational capacity. Knows physiology and functions in general (1 -2 years education program)




(1 -2 years education program) Knows principles of personal care

Assistances in daily activities

Implements daily activities

FIRST AID AND PHARMACEUTICALS ASSISTANCE

(1 -2 years education program) Knows basic anatomy and physiology Knows nursing aids Knows how to act in emergency situations

Implements simple technical procedures Resuscitates

Works by guidance of home care nurse

COMMUNICATION Knows interpersonal skills and techniques of communication and principles of communication in different situations. Knows the Code of Ethics.

Supports client and his/her family Uses communication skills based on win-win (such as contact taking-holding-finishing, active listening,

Guides the client and his/her family Understands and responds to customer messages based on

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clear self-expression and assertiveness skills). Is able to prevent conflicts and/or resolve them constructively. Makes work-related choices and decisions and solves problems. Communicates with customers and colleagues in a client-centred way.

the specific client. Operates in a client-centred way while keeping the role of the service provider. Acts by ethical principles. Works as a team-member while

HOME CARE NURSE/CARE WORKER ‘Altenpfleger’ (EQF4)

ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

HOUSEHOLD CHORES

Knows practical principles of household and cleaning Knows living environment of elderly people Knows income security Knows nutrition and healthy diet

Has skills in household chores (cleaning, washing, taking care of clothes), procurement of food and shopping, other necessities and firewood or other fuel Notices a healthy diet and nutrition Organises safety living environments

Organizes domestic work Gives information and assistance in administrative matters, etc. Takes care of the environment, electrical and fire safety and, where necessary, knows how to protect himself/herself and the clients. Knows how to prevent accidents and injuries at work.

SUPPORT ABILITY TO FUNCTION AND ACTIVATING CLIENT

Knows ageing changes and the resulting personal needs and restriction of operational capacity. Knows physiology and functions in general. Knows physical and psychosocial changes of ageing


Has skills to utilise the clients' capacity and activate it, can create a cosy, aesthetical, and simulative environment (music, dancing, gymnastics, games, walking,

Gives information and assistance in administrative matters, etc. Uses activating methods in the client work while considering other workers and the agenda. Activity-oriented and exemplary conception

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memory, memory exercises, literary activities like reading etc., crafts, baking, everyday activities etc.).

Can assess, plan, and act with clients with different operational capacity in groups and individually.


Knows principles of personal care Knows standards of Hygiene Knows the most common diseases of different organ systems, influencing factors, and the main principles of care. Knows the care principles for a dying client. Takes advantage of the information on the work of the elderly, the physical and psychological illnesses and their treatment: the care of the mouth, skin, and feet; methods of physical activity and activity of physiotherapy; eating habits; nutrition and dieabetes, pain treatments; memory disorders and their treatment; accident risks in the elderly first aid

Helps and guides in hygiene and dressing, considering clients' special problems (the care of the mouth, skin, and feet) Assistances in daily activities (supports continence, eating and drinking, respiration etc.) Implements caring activities Notices the client's ability to cope, his/her habits, beliefs and life experiences, and notices the potential social problems as well as the needs of care services. Is able to identify changes in the elderly client's health status and act accordingly. Is able to assist clients' living arrangements(care and nursing activities) Guides clients to use facilities and gerotechnology

Works by guidance of home care nurse and follows the caring plan. With the support of the working group, draws / develops and updates the plan together with the client and their representative and implements and evaluates it. Is able to care for elderly clients while taking into account their life experience and the needs at the institution and in home care. Can give first aid and resuscitation.

FIRST AID Knows basic anatomy and physiology, relevant disease patterns Knows nursing aids Knows how to act in emergency situations

Implements simple technical procedures Gives first aid for seizures, accidents and trauma. Defines the health status Resuscitates Assists in nursing activities

With the support of the working group

COMMUNICATION Knows interpersonal skills and techniques of communication and principles of communication in different situations.

Supports client and his/her family Uses communication skills based on win-win (such as contact taking-holding-

Guides the client and his/her family, motivates and activates clients Understands and responds to customer

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Knows the Code of Ethics, care-work regulating maintenance manuals, and legislative acts. Knows how to use maintenance manuals and legislative acts in elderly-work. Knows the management of social services.

finishing, active listening, clear self-expression and assertiveness skills). Is able to prevent conflicts and/or resolve them constructively. Makes work-related choices and decisions and solves problems. Communicates with customers and colleagues in a client-centred way. Can act as a team-member and collaborate with other professionals and service providers.

messages based on the specific client. Operates in a client-centred way while keeping the role of the service provider. Acts by ethical principles. Works as a team-member while respecting the principles of the work-group

WORKING IN TEAM Knows the main principles of teamwork and how to use a variety of teams to support people.

Organises teamwork Supports colleagues, solves problems Chooses a suitable communication form Delegates work

Organises, advices and leads team Works with elderly, children as well with people of special needs

20.2.1 References

Adequate social protection for long-term care needs in an ageing society. Report jointly prepared by the Social Protection Committee and the European Commission services. Council of the European Union. Brussels 2014. ec.europa.eu/health/ageing/docs/ev_20140618_co04_en.pdf

Home Care across Europe Case studies 2013. http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf Nowack Sabine G. – Boldajipour, Sigried. BACKGOUND RESEARCH and Vocational Education in the field of Elderly Care in Germany and Bremen. 2013. PP

presentation in ECVET for Elderly Care seminar.

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21 OLDER PERSONS HOMECARE IN GREECE

21.1 Overview on the older persons homecare service in Greece

21.1.1 The context of home care

Greece’s population is one of the most old of the EU countries; the over 65 aged population in 20008 was

18,6% (average in EU27 17%) and will increase until 2030 becoming the proportion of over 80 more than

double (Eurostat 2008). Moreover due to the distribution of the Greek territories, where there are islands and

mountains, home care is often fragmented and difficult to implement. The healthy trends of population show

that only 20.7% of Greek males and 24.5% of Greek female reported having longstanding disease or health

problems, compared with 29.4% of males and 33.5% of females for EU27 (Eurostat 2010),

The setting of healthcare in general and of homecare need to take into consideration also some social issues

such as: an high level risk of poverty for elderly (in 2008 22%, Eurostat, 29-01- 2010) and pension replacement

rate.

In Greece the percentage of GDP spent on care for older adults is very low compared with the average of the

EU27, less than one fifth (Eurostat, 12-02-2009).

The law that governing the home care , delivered in 2001 and then reviewed in 2009, designed in detail the beneficiaries of the services (inclusion social and domestic care), the activities to be conducted and the professionals involved. The demand of home care is rapidly increasing and the budget seems to become too limited for the total amount of demands. The health care sector is mainly, more than 75% of the total costs, financed by national taxation and EU founding. Payment based on social insurance funds or private one are not allowed by publicly funded homecare. There are private homecare providers that provides services non reimbursable but some supplementary services (physiotherapy) can be partially funded through social insurance funds. The main actors involved in the home care delivery are: Ministry of Health and Social Solidarity( responsible

for regulation of the services) Ministry of Employment (responsible for founding a part of the care services)

Central body of the Local Authorities (KEDKE) (responsible for assessing the founding to home care services);

Municipalities and Local Authority (responsible for providing social home aid through social enterprises and

management of Open care centers –KAPI that provide health home care). Included in the home care setting,

but in a marginal role, can be considered also NGO and Social insurance funds, responsible respectively of

providing home care services for members and founding supplementary home care services. The services

public founded are reserved for people who fulfil the requirements defined by Law: dependent, without

caregivers and with low income, need the be supported to live independently.

21.2 HHCP involved in older persons homecare service in Greece: roles and

competences Despite the lacks of statistical data on HHCP, it’s estimated that there are around 120000 people working in

homecare sector, not only with older adults. Most of them are employed by Agencies and partially work

privately. There is a huge amount of specialized doctors, but indications from Hellenic Ministry of Health

seems show the lack of nurses and GP (who are far below the European average in the number of

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professionals per inhabitant). Most of the employers in homecare sector, especially for older adults are

undeclared workers, often immigrants, women, middle aged.

The system, introduced in 2009, regulating the homecare services provide a detailed description of activities

and tasks and time included in the Homecare services. Despite this national guidelines there are several

differences depending on the Local Governments, founding availabilities and professionals.

The education levels are defined by law on homecare in detail for the three main categories’ of professions

involved in homecare service delivery (Table 35): Social workers, specialized in need assessment and

coordination of the other professionals during the intervention; Nurses, professionals providing basic health

care intervention, and home helps and support in daily living.

Table 35: “Social Care” / “Help at Home” programmes and Centers for Daily Care for the Elderly (KIFI)

The levels of education required to perform homecare services are defined by law and supported by

professional unions. For social workers, physiotherapist, Occupational therapist and nurses the levels

required is normally university degree, instead for home help is mandatory secondary education or equivalent.

despite the definition of the levels of education required most a large portion of workers in homecare with

older adults have no receive vocational training.

There are no specific educational requirement for work with older adults. Leonardo Da Vinci Programme

financed in 2008 the EU project ECVC “Elderly Care Vocational Certificate”, to create a system of vocational

training to provide the participant an ECVC “Elderly Care Vocational Certificate”

The Elderly Care Vocational Certificate empowers learners with theoretical knowledge enriched with practical

experience on the following subjects: Vocational awareness; Basic ageing pathology; Environmental care; Basic

body care; Hygiene; Nursing; Handling incontinence; First aids; Physiotherapy; Mobility and entertainment;

Tools and materials

The Hellenic Agency for Local Development and Local Government suggest, in addition to the competences of

the specific profession, that the homecare workers should have obtained also the following transversal

competences and skills: Social characteristics (patience, kindness, etc), Organizational skills (especially for

social scientists, responsible for the coordination and operation of the unit) Communication skills, Ability to

understand the seriousness of situations

“Social Care” / “Help at Home” programmes Centers for Daily Care for the Elderly (KIFI) Social Scientist: Nurse

Social worker Social service care taker

Psychologist Home helper

Sociologist

Nurse

Home helper

Doctor

Nurse assistant

Physiotherapist

Occupational therapist

Administrative staff

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21.3 HHCP involved in older persons homecare service in Greece: roles and competences

SOCIAL SCIENTIST / SOCIAL SERVICE CARE TAKER

ROLE / OCCUPATION KNOWLEDGE SKILLS COMPETENCIES

HEALTH MONITORING

to know the main indicators of risk conditions

health and needs of older adults

information, recording / assessment of

his needs

to evaluate an health need in home

environment

to know the network of services which can

support older adults at local level

forward of needs to appropriate

services

to evaluate the usefulness / necessity

of activating a service

ORGANIZATION /

COORDINATION DUTIES

Management and coordination skills coordinating the other staff,

scheduling the visits,

Collaborate with other professionals

for the design and implementation of

coordinated measures to know the network of services which can


cooperating with other local/public

agencies)

to know the network of services which can


Mediate to Public Services on behalf

of the beneficiary

SUPPORTING THE

BENEFICIARY’S FAMILY

Know the basics of hygiene and preventive

sciences for understanding the determinants of

health, risk factors, prevention strategies, both

individual and collective, and interventions aimed

at promoting the health and safety of their users

informing the family for the services

provided

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NURSE:


PREVENTION

Know the basics of hygiene and

preventive sciences for understanding

the determinants of health, risk

factors, prevention strategies, both

individual and collective, and

interventions aimed at promoting the

health and safety of their users

Tanking action to intervene in

personal hygiene

Evaluating an hygiene risk

To educate people in healthy lifestyles

and change those at risk

NURSING CARE

Knowing the biological phenomena of

the main operating mechanisms the

organs and apparatus, inheritance,

and physiological phenomena, also in

correlation with the psychological,

social and environmental health and

disease.

Implement nursing care by

customizing the choices based on

similarities and differences between

people assisted compared to values,

ethnicities and socio-cultural practices;

Take decisions nursing care intervention;

Knowing the basics of physiology and

pathology applicable to different

environmental and clinical situations

of the person

Establish with technical and structured

and systematic manner the client's

care problems through the

identification of alterations in

functional models

Critically evaluate the outcomes of the care decisions made on the basis of the person's answers and care standards

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Know the main nursing care needs of

the elderly person

Identify the needs of nursing care of

the elderly person

Prioritize interventions based on care needs, organizational needs and optimal utilization of available resources;

HEALTHCARE EDUCATION Know the theories of learning and

change for the understanding of

educational processes for citizens or

patients;

“Training” person of the family who

cares the old man, to basic daily

activities

Supporting the beneficiary’s family

HOMECARE ASSISTANT / HOME HELPER:


PREVENTION Know the basics of hygiene and

preventive sciences for understanding

the determinants of health, risk

factors, prevention strategies, both

individual and collective, and

interventions aimed at promoting the

health and safety of their users

House cleaning

Personal hygiene

ACTIVITIES OF DAILY LIVING SUPPORT to know the basics of nutrition

principles

preparing food

to know the basics of food

preparation

to know the basics of domestic Going to market (purchase of food

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economy and medicines)

to know the basics of nutrition

principles

NURSE ASSISTANT


NURSING CARE Knowing the biological phenomena of the

main operating mechanisms the organs and

apparatus, inheritance, and physiological

phenomena, also in correlation with the

psychological, social and environmental health

and disease.

Basic nursing interventions (blood

pressure, vaccines, etc)

PERSONAL CARE Know the basics of hygiene and preventive

sciences for understanding the determinants

of health, risk factors, prevention strategies,

both individual and collective, and

interventions aimed at promoting the health

and safety of their users

Assist for personal care (personal

hygiene)

HEALTHCARE EDUCATION Know the theories of learning and change for

the understanding of educational processes

for citizens or patients

Training” the person of the family who

cares for the elderly to perform basic

daily activities

Supporting the beneficiary’s

family

Supporting the beneficiary’s family

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PHYSIOTHERAPIST


PHYSIOTHERAPIC INTERVENTIONS


the main operating mechanisms the

organs and apparatus, inheritance,

and physiological phenomena, also in

correlation with the psychological,

social and environmental health and

disease

Establish with technical and

structured and systematic manner the

client's care problems through the

identification of alterations in

functional models

Critically evaluate the outcomes of the care decisions made on the basis of the person's answers and care standards

Implementing the assistance physiotherapy customizing choices on the basis of similarities and differences between people assisted with respect to values, ethnicities and socio-cultural practices;

To plan appropriate care interventions

that take into account the values and

guidelines of the people

HEALTHCARE EDUCATION

Know the theories of learning and change for the understanding of educational processes for citizens or patients; Training person of the family who care

the old men

using appropriate communication

modes with the caregiver

Know the elements of psycho-social sciences and humanities for the understanding of normal and pathological relationship dynamics

PREVENTION Basic knowledge of safety in home

environment

Assessing “operational” and safety

parameters of the beneficiary’s home

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OCCUPATIONAL THERAPIST:


OCCUPATIONAL THERAPY

INTERVENTIONS


the main functional mechanisms of

functioning and psychological well

with the social and environmental

dimensions of health and disease

make a practical and psychological evaluation of

the subject and elaborates, in multidisciplinary

teams, the definition of the rehabilitation

program, aimed at identifying the needs of the

disabled person and his goodwill towards personal

autonomy in the environment of everyday life and

in

use both individual and group activities,

promoting recovery and optimal use of functions

aimed at reintegration, adaptation and integration

of the individual in their personal, domestic and

social;

PREVENTION AND PROMOTION OF

HEALTHY LIFESTYLE

Basic knowledge of safety in home

environment

Assessing “operational” and safety parameters of

the beneficiary’s home

proposes, as necessary, changes to the living

environment and promotes educational activities

at the subject being treated, to the family and the

community

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22 OLDER PERSONS HOMECARE IN HUNGARY

22.1 Overview on the older persons homecare service in Hungary Hungary is a Central- European country with 10 million habitants. The socio-demographic context in Hungary is

characterized by population ageing and a general decrease in the population size. The population over 65 and

80 are currently 17% and 4% respectively.

It has an insurance-based public health care system funded by income-related social health insurance

contribution.

In Hungary, long- term care patients can receive services both from the health and the social care systems. The

health care system operates under de National Health Insurance, while the social care system is managed at a

local level.

The central government is responsible for the health care legislation, as well as the financing for Long-term

care. The local governments assume primary responsibly for organizing and delivering social care, which

includes home care and nursing care, under the framework set out by the central governments.

Home care as defined in Hungary includes:

- Domestic care: Basic social service provided to persons being unable to care for themselves in their

home as well as to psychiatric patients, disabled persons and addicts who due to their condition, need

help in performing the tasks necessary for independent life.

- Club for the aged: provides day care for elderly people who are partially capable of looking after

themselves and in need of social and mental support, and enables them to maintain social relations,

satisfy basic hygienic needs and to get daytime meals upon request.

- Day home for disabled: enables disabled or autistic person o over three years of age living in their own

homes and not needing supervisions to find daytime shelter, maintain social relations and satisfy basic

hygienic needs and to get daytime meals upon request.

The health care systems provides a primary medical assistances, operates a domestic medical nursing service

for limited number of visits, and provides continuous outpatients special care for different type of chronically

ill patients.

Institutional care is only provided to individuals who require more than 4 hours of help per day. Individuals in

need of 2 to 4 hours of care receive home care services, while those who require less than 2 hours of care per

day receive no public assistance. Benefits are set at a national level but are often supplemented by additional

benefits provided by local authorities.

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22.2 HHCP involved in older persons homecare service in Hungary: roles and competences

SOCIAL SCIENTIST / SOCIAL SERVICE CARE TAKER


Perform basic tasks related to the care

of assigned patients. To know the material and instruments

To prepare the necessary means to

different instrumental tests and

laboratory and diagnostic and

therapeutic interventions.

To assist in the conduct of laboratory

test and instrumental.

To create an atmosphere of care

insurance, treating materials and

infectious instruments according to

the rules

To store instruments, textiles and

bandage that help care.

CARE ASSISTANT


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TAKE CARE

Verbal and non-verbal

techniques to communicate in

the correct way with families

and partners (medical

terminology)

knowledge of Physiology,

pathophysiology and clinical

during the conduct of their

work.

First aid knowledge

Basic pharmacology knowledge

To communicate with patients, family members

and other members of the Group's care.

to apply both the spoken and the written

medical terminology.

To observe and interpret the symptoms of the

patient, indicate what that differ from the

physiological.

To carry out the work according to the basic

principles of Psychology care and the ethics of

care.

To provide first aid care to people who have

had an accident.

To perform tasks related to the medication

orally, cutaneous or mucous, as well as the

administration of subcutaneous injection of

insulin following the instructions above. -To

apply the resources. And transmission of

information.

To help the nurses / doctors during diagnostic

and therapeutic procedures.

To carry out the documentation of care realted

to their work

To help sick people / healthy of different ages

in their physiological needs.

To help in movement, rest, food, hygiene,

selection, maintenance of proper body

temperature functions and ensure the level of

oxygen necessary according to the State and

the needs of the patient.

To develop their skills continuously.

To perform tasks related to the deceased.

to perform and develop first aids techniques

and knowledge in order to help in which it is

necessary.

To organize its work according to the principles

of care processes

To meet the standards of labour safety, fire

protection and prevention of accidents during

the conduct of their work.

To assist in the conduct of laboratory test and

instrumental.

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GERONTOLOGICAL NURSE

ROLE KNOWLEDGE SKILLS COMPENTENCIES

To perform basic care duties in institutions providing care for the elderly, based on the doctor´s diagnosis, according to nursing protocols as a member of a team or individually, among elderly people with chronic diseases.

-First aids knowledge.

-Investigation and resources techniques.

-To know healthy lifestyles and how to get them

-Geriatric special care.

- To provide first aid to the patients under their care.

- To apply clinical studies in the performance of the job. -To apply their communication studies appropriately with those in care and their relatives as well as their colleagues. - To compile an environmental study, establish and analyze a nursing anamnesis, apply social psychology, socio-cultural studies.

- To perform health education work based on modern health pedagogy studies for the patients in their care and their relatives

- In welfare institutions providing help for the elderly, together with the nursing team perform special nursing jobs among the elderly suffering from diseases related to age, - To take part in hospice care.

- To perform helping tasks in the framework of hospital social work.

- To be update in the last care scientific progress and to apply those progress in the daily work.

-to promote a healthy life, trying to eliminate bad health habits as smoke, drink too much alcohol…

-To participate in the care of elderly people suffering from oncology diseases and in a terminal illness. -To help to organize the daily activities of the elderly, compile schedules for the activities of the elderly, compile a rehabilitation plan and provide help in their implementation.

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-To know verbal and non verbal techniques to the management of the aggressive patient

-Bioethical, Legislative and administrative knowledge

- To help the elderly in a crisis situation or a deviant state to regain their mental balance.

- To perform their work in accordance with ethical norms.

-To provide for the storage, records of nursing and therapeutic tools, document their activities by using their IT knowledge. -To provide help in request for social benefits and allowances, to arrange administrative tasks, and represent the interests of the patients in their care. -To coordinate the work of the team performing the nursing tasks, establish relationships with non-governmental organizations for the sake of the patients under their supervision.

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23 OLDER PERSONS HOMECARE IN IRELAND

23.1 Introduction to older persons homecare service in Ireland

In Ireland the main government departments responsible of the home care for elderly people are:

“Department for Health and Children”, “Department of Social and Family Affairs” and “the Department of

Finance”.

Caregivers dependent of these departments have developed a document in 2008 known a “Long Term Care

Report” which reflects many of the objectives that have influenced the current policies of the home-based

caregivers in the country. In practice, there is a dominant strategy of the “Health Service Executive (HSE)”

which is recruiting a significant number of health professionals and social workers, in addition to volunteers

and other workers.

The following demographic statistics are from Ireland's Central Statistics Office (CSO), Eurostat and the CIA

World Factbook.

Population

65 years and over: 11.7% (male: 243,314; female: 292,079)

Sex ratio

a) 65 years and over: 0.8 male(s)/female

b) total population: 0.99 male(s)/

Life expectancy at birthtotal population: 80.19 years

a) male: 77.96 years

b) female: 82.55 years

When choosing the home-based caregivers there are a wide variety of criteria according to the different

regions, due to the lack of a national standardisation.

Home help and the personal care delivery is widespread in Ireland and is financed by the State and other

Regional Institutions of the “Health Service Executive (HSE)” that allow an assistance funding through co-

payment for those elderly people who are not entitled to a health card.

Family caretakers in Ireland are being recognized as a group of citizens with special rights. 60% of these family

caretakers spend between 1-19 hours on caring responsibilities and 27% spend more than 50 hours per week

caring for their relatives.

Ireland, for its part, has had an important growth in the private sector in these type of services. The main

difficulty at national level is in the low-wages, particularly for unskilled workers.

Regarding nursing professionals, they follow university training with general knowledge about health, in the

community and public health, providing primary health care; skills on health care organisation, leadership,

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evidence-based health and skills on professional and personal development, the influence of society

concerning health issues, negotiating skills, knowing how to respect people and defend their dignity.

Specialised training is only available in palliative care and dementia.

Figure 24 - Population in Ireland 2014

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23.2 HHCP involved in older persons homecare service in Ireland: roles and competences

NURSES

Role/

Occupation EQF

Knowledge


knowledge

Skills


practical

Competences

know how to be

General

cares 6

○ Concepts of health, of community and

of public health.

○ Public health theory and practice at a

National, European and International

level

○ Public health in community practice

○ Primary health care

○ Determinants of health: biological,

behavioural, gender, social,

environmental, economic, educational,

political and cultural factors affecting

health

○ Infectious/communicable diseases,

screening and surveillance

○ Risk assessment, and measures of

health

○ Environmental health

○ Professional values in the provision of

public health - an understanding of the

current climate and political influences

○ Holistic Approaches to Care and the

Integration of Knowledge

○ Organisation and Management of Care.

○ Leadership skills

○ Evidence based health care and information

technology

○ Strategic planning and forecasting

○ Equity in health and health care

○ Professional/Ethical

Practice.

○ Interpersonal Relationships.

○ Personal and Professional

Development.

○ Influence of society on

health

○ Psychological theory and its

application to public health

nursing.

○ Negotiation and influencing

○ Nurses respect each person

as a unique individual

○ Nurses respect and defend

the dignity of every stage of

human life

○ Nurses respect and

maintain their own dignity

and that of patients in their

professional practice. They

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on health care, the values, priorities

and contributions of health

professionals.

○ Knowledge and skills for effective

management.

believe that this respect is

mutual with patients.

○ Nurses are expected to

show high standards of

professional behaviour.

○ Nurses are professionally

responsible and

accountable for their

practice, attitudes and

actions including inactions

and omissions.

○ Nurses advocate for

patients’ rights.

COMMUNITY NURSING ASSISTANTS

Role/ Occupation EQF

Knowledge


knowledge

Skills


and practical

Competences

know how to be

Perform duties and

tasks to facilitate our

customers to live at

home and in their

communities in a safe,

secure and

comfortable way.

3-4

○ Defining health and wellness

○ Determinants of health

○ Illness behaviour and the sick role

○ Health promotion

○ Defining rehabilitation

○ The multidisciplinary team

○ Rehabilitation nursing practice

○ Pharmacology

○ Using Medical Terminology

○ Security Procedures

○ Codes of Conduct

○ Confidentiality & Privacy

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HEALTH CARE ASSISTANTS

Role/ Occupation EQF

Knowledge


knowledge

Skills


practical

Competences

know how to be

Determined by staff

who had completed

the Health Care

Assistant's course,

staff undergoing the

course and then

seniority of staff.

3-4

○ Ensure dietary needs are adhered to,

including special diets and supplementary

drinks under the direction of the nursing

staff.

○ Recording care plans, vital signs and fluid

balance.

○ Reporting to nursing staff any complaints

of pain, distress etc. from clients

○ Assisting residents with their hygiene needs,

such as, bathing, hair care, shaving, dressing

and undressing.

Pressure area care.

○ Helping those who need help at meal times.

○ Cleaning and restocking of linen

presses/wardrobes and ensure personal

clothing is in the correct locker/wardrobe.

23.2.1 References

International Career Institute. Nursing Assistant [Internet]. Retrieved from: http://ici.edu.au/courses/health-and-fitness/nursing-assistant/

Peppard L. Health Service Executive [Internet]. Retrieved from: http://www.hse.ie/eng/staff/jobs/profiles/careassistant.html

Hillery M. Family Caring in Ireland [Internet]. Dublin: Care Alliance Ireland; 2013. Retrieved from: http://www.carealliance.ie/userfiles/file/Report 2013 FA

130513.pdf

Management competency wheel for nurse and midwife managers [Internet]. Office for. Retrieved from:

https://pnd.hseland.ie/download/pdf/nursecomps_complete.pdf

Nursing and Midwifery Board of Ireland (2014) Code of Professional Conduct and Ethic for Registered Nurses and Registered Midwives Dublin, NMBI. Retrieved

from: http://www.nmbi.ie/ECommerceSite/media/NMBI/Publications/Code-of-professional-Conduct-and-Ethics.pdf?ext=.pdf

Nursing and Midwifery Board of Ireland (NMBI). Public Health Nursing Education Programme [Internet]. Ireland; 2014. Retrieved from:

http://www.nmbi.ie/ECommerceSite/media/NMBI/Publications/public-health-nursing-education-programm-standards-requirements.pdf?ext=.pdf

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24 OLDER PERSONS HOMECARE IN LATVIA

24.1 Introduction to older persons homecare service in Latvia

In recent years the demand for social care services in Latvia has increased substantially. This trend can be explained by the ageing of society. According to the latest estimates of the Central Statistics Bureau, there were 2,248,374 residents in Latvia at the beginning of 2010. Among them, 390,209 were older than 65, while the remaining 1,858,165 were aged under 65. As of 1 January 2016, the population of Latvia was estimated to be 1 956 526 people. During 2016 Latvia population is projected to decreased by -23 126 people and reach 1 933 400 in the beginning of 2017. The number of deaths will exceed the number of live births by 8 980, so the natural increase is expected to be negative. If external migration will remain on the previous year level, the population will be declined by 14 146 due to the migration reasons. (http://countrymeters.info/en/Latvia.) Professionals at the University of Latvia Centre of Demography forecast a significant 20% drop in the number of residents to 1,872,855 until 2050, due to the decreasing birth rate (http://www.ancien-longtermcare.eu/sites/default/files/ENEPRI%20_ANCIEN_%20RR%20No%2081%20Latvia%20final.pdf). Therefore, an increase in elderly persons needing long-term social care is certain. 16,9 % from the total population are over 64 years old: from 331 612 persons 107 883 are males and 223 729 females. Total life expectancy (both sexes) at birth for Latvia is 72.7 years. (http://countrymeters.info/en/Latvia.) Latvia is one of the three Baltic countries which have similar political and economic development during 20th century. Latvia was re-established as a democratic state on 1918. It remained independent until the outset of World War II, when it was occupied by the Soviet Union for nearly 50 years. Since the declaration of Latvia’s independence in 1990, there have been a series of economic and social reforms leading to steady economic growth and stability. Latvia is divided into 118 administrative divisions, of which 109 are municipalities and 9 are cities. (https://en.wikipedia.org/wiki/Latvia.) Since regaining independence in 1990, Latvia’s path towards a structured social insurance system started in 1991 with the founding of the Ministry of Welfare. The ministry managed policy issues in social security, work, health and gender equality. There is no separate system for providing long-term care in Latvia and it is divided between the health and welfare systems (2003). The strategic aim of Latvia’s health and welfare systems is to provide mental, physical and social welfare as close as possible to clients’ homes. Social care services seek to maintain the existing quality of life of clients who are unable to sustain it themselves (para. 18, Law on Social Care and Social Assistance). The explicit target group of the long-term care system in Latvia is those over age 62, because currently people retire at that age. Long-term care in Latvia is managed on three levels: the state, municipality and social service provider. The first level involves the Ministry of Welfare and to some extent the Ministry of Health as well. They draft legislation, develop policies and standards, implement policies and monitor service providers as well keep the register of social services providers. At the second level, municipalities develop social service conceptions, proposals for the introduction of new services, perform research in the field and monitor social service providers. Social service workers assess client needs and resources, and provide services to clients. A client’s ability to pay for such services is assessed as well. The general problem that affects home care is the lack of social work professionals in Latvia. Increasing the number of educated social-work professionals has been among Latvia’s priorities since 2005. This situation has arisen because of the low salaries and disadvantaged working conditions in the field. At the end 2008, only 49% of all municipal social workers had an appropriate level of education in this field (Ilves–Plakane, 2011: 8). During the economic crisis of 2008–09, the policy centered on creating a social insurance net for those in severe financial need. Developing alternative social-care services is also part of the current policy debate. The main focus today,

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however, is on integrating the aged and the disabled into society, as well as on developing and implementing an improved quality control system for long-term care service providers. Care at home can be received by individuals who cannot take care of themselves because of old age, their state of health or functional impairments. Home care services are provided by either the municipal social services or by non-governmental or private organizations with which the municipality contracts. (para. 22, Law on Social Care and Social Assistance). Home nursing is a process where the health care services are performed by certified nurses’ or doctors’ assistants at the patients’ place of residence. The patient is provided with health care services at home if he needs a regular outpatient treatment, but he is not able to arrive to the medical institution to receive a treatment according to the medical indications. (http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf.) The main welfare basis for regulating long-term care is the Law on Social Services and Social Care. The Law on Social Security outlines the basic principles for the social security system and specifies the key social rights and duties of benefit recipients. Cabinet Regulation No. 288 prescribes the procedure according to which residents can receive social care and Regulation No. 275 describes the organization of payment for social care. (Ilves–Plakane, 2011: 5.) The health care services provided by long-term care institutions and formal, home-based nursing care are regulated by the Law on Health Care, the Law on Patient’s Rights, Cabinet Regulations No. 60 on “Mandatory requirements for health care institutions and their branches”, No. 574 on “Regulations on hygienic and anti-epidemic requirements for health care institutions” and No. 1046 on “Regulations for health care organizing and financing”. Lastly, the Law on Financing and Management of the Health Care System lists those health care services that are financed by the state. (Ilves–Plakane, 2011: 5.) The clients of long-term care services are asked to pay for the services they receive, but if they are unable to do so or if they can only pay a portion, the state takes over the payment. In general, the state and the municipalities are responsible for financing long-term care even if there are no client co-payments. Latvians are financially liable for their parents’ care costs and their ability to care is taken into account. One third of the population over 65 is at highest risk of poverty in Europe. Almost half of respondents answered that care should be provided by close relatives, even if it would affect their career. Home care provided by professionals is perceived less favorable, even compared to nursing home care. Asked about preferred options for their dependent elderly parents, only 10% mentioned professional home care. (http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf) Activities of home care providers are limited by volume of health care budget. Home care is funded by national revenue including income and consumption tax revenue and for services outside the benefit package by private payments. Home help services are funded through the municipal budget and client co-payments. Privately hired services are paid completely out-of-pocket. Health care at home providers are generally paid per visit, irrespective of the service. Medication, such as injections provided during the visits, is paid per ‘doses’. In the price of public home health care (as health/medical care) visit are included salary, transport, basic medicine and medical goods and additional (indirect) costs. The prices of domestic aid and personal care are fixed per municipality and usually they do not covet transport costs. (http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf) Peoples who need (social) home care can choose between private home care and social home care, depending on the number of providers available. For the patient it is cheaper to stay in an institution. There is a lack of both informal carers and formal carers in Latvia. Only municipalities having more than 3,000 inhabitants were obliged to have a social care office. Small municipalities are not obliged to organize social care. Especially in rural areas conditions for home care are poor. A ground for unmet needs is that clients can only have health care at home once a day. (http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf)

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Formal care makes up the vast proportion of long-term care services. There is an insignificantly small proportion of informal care in Latvia, and thus no data on it. The country’s economic situation discourages widespread informal care, such that families are not financially secure enough to leave jobs and take care of their relatives. In addition, no legislation focuses on informal care. Developing alternative social-care services has been the Ministry of Welfare’s priority. The first initiative is called “Safety button”, and has been launched by the Latvian Samaritan Association. It has an operations unit that is contactable 24 hours a day and which reacts to any health or household problems that an elderly person might experience at home. Other initiatives include a course on social care organized by Latvia’s Evangelistic Church and home health-care lectures by the nurses’ Care Service that are available to the clients’ families. Still, it is necessary to mention a problem that affects all kinds of care, which is the lack of social work professionals in Latvia. This situation has arisen because of the low salaries and disadvantaged working conditions in the field. (Ilves–Plakane, 2011: 8.)

Home care is organized by the respective municipality’s social services. Either the municipal social services provide home care to its residents or it contracts with an NGO or private organization to provide such services. Of the 118 municipalities, the social services of only 30 provided home care themselves and 8 municipalities purchased home care either from NGOs or from private institutions during 2009. In the other 80 municipalities, home care services were not available. The share of municipalities without home care is large for two reasons. First, some local governments are unable to provide social services because of a lack financial and staff resources. Second, the low density of residents in some rural areas makes the supply of social care services cost ineffective. Furthermore, reaching isolated rural homes on unpaved roads can become impossible in autumn and winter; thus, it is safer to transfer these clients to long-term care institutions at once. Very often home-care clients receive additional services, such as a hot dinner and a ‘safety button’ service. The safety button offers the possibility to reach a relief service 24 hours per day and is provided by the NGO, the Samaritan Association. The Samaritan Association has signed a contract with the local governments of Riga, Rēzekne and Liepāja. Residents of other local government areas can purchase similar services individually. (Ilves–Plakane, 2011: 10.) There are following practitioners working in home care services in Latvia: carer, social carer, social worker and certified nurses or doctor’s assistans. Education is not required by carer, but they are usually trained by the provider; mainly providing personal care services. Social carer has two years education of mainly higher professional education providing personal care services and coordination. Social worker involved in coordination with other care providers and has four years degree obtained at any type of higher educational establishment. Certified nurses (three years education) or doctor’s assistants (three years education): providing medical care at home, informing and instructing clients and their families (http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf).

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24.2 HHCP involved in older persons homecare service in Latvia: roles and competences

SOCIAL CARER



SKILLS as cognitive and practical COMPETENCE in terms of responsibility and autonomy

PERSONAL CARE SERVICES AT HOME

two years of mainly higher professional education providing personal care services and coordination;

Proceeds personal care services

Gives information and assistance in administrative matters, etc. Advices carer

COORDINATION two years of mainly higher professional education providing personal care services and coordination;

Organizes domestic work Coordinates work

SOCIAL WORKER




Involved in coordination with other care providers;

four years degree obtained at any type of higher educational establishment; involved in coordination with other care providers;

coordinates work together with other care providers

Communication Knows interpersonal skills and techniques of communication and principles of communication in different situations.

Supports the client and his/her family

Guides the client and his/her family Guides the other care providers

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Advising Guides the client. Guides the other care providers

CERTIFIED NURSES OR DOCTOR’S ASSISTANTS




PROVIDING MEDICAL CARE AT HOME

(three years education) or (three years education): Knows medical care

Provides medical care coordinates work together with other care providers

COMMUNICATION AND ADVISING

Knows interpersonal skills and techniques of communication and principles of communication in different situations.

Informs and instructs clients and their families, and supporting the GP when necessary.

Guides the client and his/her family Guides the other care providers

24.2.1 References

Kaspar Ilves and Baiba Plakane:The Long-Term Care System for the Elderly in Latvia, 2011. ENEPRI RESEARCH REPORT NO. 81 MAY 2011 The long-term development guidelines for LTC policy were set by the National Development Council in 2010. The Sustainable Development Strategy of Latvia until

2030 (NDC, 201) http://www.ancien-longtermcare.eu/sites/default/files/ENEPRI%20_ANCIEN_%20RR%20No%2081%20Latvia%20final.pdf

http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf

http://projects.centralbaltic.eu/project/473-innocare http://innocare.edicypages.com/

http://countrymeters.info/en/Latvia

https://en.wikipedia.org/wiki/Latvia

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25 OLDER PERSONS HOMECARE IN LITHUANIA

25.1 Introduction to older persons homecare service in Lithuania

As of 1 January 2016, the population of Lithuania was estimated to be 2 850 400 people. Since 1990 the number of births has been diminishing, the number of deaths has been growing and the population deceasing (forecast for 2030 is 21,). During 2016 Lithuania population is projected to decreased by -46 433 people and reach 2 803 967 in the beginning of 2017. The number of deaths will exceed the number of live births by 14 223, so the natural increase is expected to be negative. If external migration will remain on the previous year level, the population will be declined by 32 210 due to the migration reasons. It means that the number of people who leave Lithuania to settle permanently in another country (emigrants) will prevail over the number of people who move into the country (to which they are not native) in order to settle there as permanent residents (immigrants). The sex ratio of the total population was 0.867 (867 males per 1 000 females) which is lower than global sex ratio. 16,5 % from the population are older as 65 years. Total life expectancy (both sexes) at birth for Lithuania is 75.3 years. (http://countrymeters.info/en/Lithuania). The results of the European Commission’s survey on ageing (2009) indicate that life expectancy at birth will increase to 80 years for men and to almost 87 for women by 2060. It is foreseen that life expectancy at age 65 will increase to 20 additional years for men and almost 24 for women, which is below the average of the EU (the corresponding numbers are 21.8 for men and 25.1 for women). It is estimated that every third inhabitant of Lithuania will be an elderly person in 2050. Lithuania was re-established as a democratic state on 1918. It remained independent until the outset of World War II, when it was occupied by the Soviet Union for nearly 50 years. Since the declaration of Lithuania’s independence in March 1990, there have been a series of economic and social reforms leading to steady economic growth and stability. The Lithuanian health system is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population amounting to about half of its budget. Public financing of the health sector has gradually increased since 2004 to 5.2% of GDP in 2010. The state health-care system is intended to serve the entire population, and the Health Insurance Law requires all permanent residents and legally employed non-permanent residents to participate in the compulsory health insurance scheme (typically paying 6–9% of taxable income), without an option to opt-out. The 60 municipalities (varying in size from less than 5000 people to over 500 000) become responsible for organizing the provision of primary and social care, and for public health activities at the local level. The principal guidelines for the public health service have been outlined in the Health System Law (1994), Lithuanian Health Programme (1998–2010) and the National Public Health Strategy (2006–2013). Education for social and health care practitioners is organized in universities and colleges providing vocational training. There are also six colleges providing vocational training for nurses and other health-care personnel. According to the Government Resolution of 2003, current medical training programmes cover undergraduate and postgraduate levels: six years for the diploma (four years for public health, nursing, midwifery and rehabilitation) and three to six years for residency training programmes depending on specialty. A master’s degree in public health, nursing or rehabilitation can be obtained in two years. Non-university training programmes last from two to three and a half years. (Health Systems in Transition. Vol.13, Nr 2. 2013.) The social and health care services offered to the elderly are provided through three main sectors: health care, the social welfare system and the private sector together with non-governmental organizations. Long-term care is provided in two sectors: health and social care. There is a lack of distinction across the service provision, for which no unified legal arrangements have been created, nor is there a central or regional institution that regulates LTC service procedures. The long-term care services provided by the health care

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system and social services for dependent individuals (through social services), the latter of whom include the elderly. (http://www.ancien-longtermcare.eu/sites/default/files/ENEPRI%20_ANCIEN_%20RR%20No%2082%20Lithuania.pdf.) In response to the increasing need for nursing provision, regulations and additional payments from the NHIF were introduced in 2008 for nursing services at home provided by primary care nurses. Community primary health-care institutions have been in charge of nursing services in a patient’s home. Home care includes nursing and social care services, which are provided by various professionally trained workers at the home of the care recipients. These services are provided to those who are unable to live at home independently and who have partly lost their independence through old age or disability. Long-term social care services (from 2012) are provided mostly for elderly and disabled people in need of care, according to their ability to function independently. Social services development policy is guided by the Ministry of Social Security and Labour while municipalities are in charge of social services provision. Social services provided at home are mainly publicly funded but are subject to co-payments, depending on the age and disability status of the recipient as well as household income. (Health Systems in Transition. Vol.13, Nr 2. 2013.) In social care institutions, LTC is provided for those who are totally dependent and who need the permanent care of professionally trained caregivers. The eligibility criteria for long-term care are different for the health care and social sectors. Services by the social sector are provided to a person who is by reason of age, disability or social problems partially or completely lacks, or has not acquired or has lost the abilities or possibilities to independently care for his/her private (family) life and to participate in society. The eligibility criteria include the level of dependence, the need for services, and the income and property of the individual. Cash benefits are not means tested. The benefits are paid if persons defray. (http://www.ancien-longtermcare.eu/sites/default/files/ENEPRI%20_ANCIEN_%20RR%20No%2082%20Lithuania.pdf.) In Lithuania the demand and supply of informal care have not been regularly studied. The study of the need for nursing and social services in the Kaunas district by Hitaite and Spirgiene (2007) indicated that 69.7% of elderly persons who needed home nursing were cared for by family members, 10% were cared for by neighbours and 7.7% by community nurses; only 3.8% paid for this service. The supply of informal care is still high in Lithuania. Carers and social workers provide home-based LTC, which includes nursing, shopping and help at home. In 1997, more than 2,200 carers were involved in care provision throughout the country. This number has increased, but is undoubtedly still insufficient to meet the current need. Despite the support by (non-)governmental institutions, long-term care in the community remains an activity mainly carried out by families, neighbors, friends and volunteers. Unfortunately, there is no information available on the supply of long-term care at home. (http://www.ancien-

longtermcare.eu/sites/default/files/ENEPRI%20_ANCIEN_%20RR%20No%2082%20Lithuania.pdf)

Conclusion In Lithuania home care services are in developing point. There have been a series of economic and social reforms leading to steady economic growth and stability after 50 of occupation. The health and social care systems based on three traditions:

- there is tradition to organize public care and nursing - elderly care based on hospitalization as cheaper and traditional way (long term care) - traditionally family, children and neighbors are responsible of elderly care, caring is not granted by

government and carers are untrained. -

The practitioners in home care can be formal and informal worker: Home care services are provided by social workers and self-employed house cleaners; the latter is hired by family members. Educated community nurses as well Red Cross’ nurses (without special training) can participated in home care. Domestic aid is provided by volunteers too: Samaritans, Caritas’ volunteers and Student Volunteer Organization ‘Patrica’. Courses of one to

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two months in duration are organized for volunteers; courses are obligatory. Most frequently volunteers provide help with activities of daily living and not with nursing and medical support. Finland, Estonia and Lithuania participated in Erasmus + SSA project ECVET for Elderly Care (2013 – 2014). During this project Lithuania would like to influence to image of elderly care sector and develop a new curricula for care worker. However, there was not discussion about the current situation of home care or developing of home care. Gathering information about home care sector was difficult and based only on literature revue. Unfortunately contact persons did not answers to different contacts. By background literature there is challenges of human resources issues in Lithuania and the availability of trained health-care workers and migration. The issue of health worker migration has been the subject of broad debate in Lithuania, particularly since joining the EU in 2004. A study conducted in 2006 showed that the main drivers for emigration among health and social care workers were low wages, excessive workload, poor working arrangements and unsatisfactory work environment (Health Systems in Transition. Vol.13, Nr 2. 2013). The current plans of the Ministry of Health are as follows: • To accelerate development of nursing at home, integration of nursing and care; • To assign several community nurses to a family doctor; • To allocate more social workers, especially in rural areas; • To expand rehabilitation services at home; • To develop day-stay services; • To increase the extent of personal health care services at home; • To establish units at nursing hospitals for palliative care at home; • To improve the financing for nursing care at home; • To decentralize personal health care institutions in order to improve access to the services; • To give a special attention to medical care services in rural areas; • To increase financing, to promote preventive measures, to improve the quality of nursing; • To develop long-term monitoring system for patients with chronic diseases; • To promote scientific research related to home nursing.

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25.2 HHCP involved in older persons homecare service in Lithuania: roles and competences

CARER/SOCIAL WORKER




HOUSEHOLD CHORES

Knows practical principles of household and cleaning Knows living environment of elderly people Knows income security

Has skills in household chores (cleaning, washing, taking care of clothes), shopping, other necessities and firewood or other fuel

Organizes domestic work

NUTRITION Knows basic about nutrition and healthy diet

Notices a healthy diet and nutrition Prepares meals Assistances in eating and drinking



Knows principles of personal care Knows standards of Hygiene

Takes care in personal hygiene Assistances in daily activities

Assistances

COMMUNICATION Knows interpersonal skills and techniques of communication and principles of communication in different situations.

Supports the client and his/her family

Guides the client and his/her family

ADVISING Knows the Code of Ethics, care-work regulating maintenance manuals, and legislative acts. Knows how to use maintenance manuals and legislative acts in elderly-work. Knows the management of social services.

Guides the client and her/his relatives.

Guides the client.

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COMMUNITY NURSE




NURSING AT HOME

Knowledges of the college (3 to 3.5 years) or university education (4 years): Both receive a bachelor in nursing degree after graduation. “General practice nurse. Rights, duties, competence and responsibility” (adopted by the Ministry of Health, 2004).

Visits at homes and monitors clients health condition

working together with a family doctor independent working with clients Gives information and advices

CARING ACTIVITIES Knows ageing changes and the resulting personal needs and restriction of operational capacity. Knows physiology and functions Knows principles of personal care Knows standards of Hygiene

Implements caring activities Works independentent and follows the caring plan

NURSING ACTIVITIES AND PHARMACEUTICALS WORK

Knows anatomy and physiology, relevant disease patterns Knows nursing aids Knows how to act in emergency situations Knows nursing documentation (RAI, plan for care and services) Ethics for the professional field of action

Gives first aid for seizures, accidents and trauma. Defines the health status Resuscitates Nursing activities Perform scheduled preventive measures Apply nursing aid and care techniques Document observations and measures in the nursing documentation Take measures Implements pharmacotherapy,

working together with a family doctor Works independentent and follows the caring plan

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rations and administers pharmaceuticals and monitors their effect

COMMUNICATION AND ADVISING CLIENT

Knows interpersonal skills and techniques of communication and principles of communication in different situations. Knows the Code of Ethics.

Communicates with customers and colleagues in a client-centred way. Can act as a team-member and collaborate with other professionals and service providers.

Guides the client and his/her family Plans home care plan in contact with doctor

RED CROSS’ NURSES




CARING AND DAILY ACTIVITIES AT HOME

persons without special education in nursing, who completed specific courses; Knows general principles of hygiene procedures

Perform patient hygiene procedures

NON-SPECIALISED NURSING (untrained family members or volunteers such as Samaritans, Caritas’ volunteers and Student Volunteer Organization ‘Patrica’)




DAILY ACTIVITIES AT HOME

Untrained family members or other voluntaries

Helps with activities in daily living or technical procedures Helps with feeding

CARING AND HYGIENE Courses of one to two months in Performs personal hygiene

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duration are organized for volunteers; courses are obligatory.

procedures

DOMESTIC AID

knows practical processes of domestic aid knows safety rules

Helps with activities of daily living and not with nursing and medical support.

25.2.1 References

http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf Health Systems in Transition. Vol.13, Nr 2. 2013. Lithuania. Health system review. http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf

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26 OLDER PERSONS HOMECARE IN LUXEMBOURG


In 1991, a Consultative Commission was set up to look into the possibility of creating a dependency insurance

scheme. Users, carers and voluntary as well as private organisations were all invited to participate in the

consultation which eventually led to the introduction of a dependency insurance in 1999. This was part of the

government’s dual policy to support elderly and disabled people in their own homes for as long as possible

whilst at the same time developing user-oriented care strategies.

Between 1998 and 2003, 17,933 requests for assistance were registered by the Ministry of Social Security. Of

these, 83.2% were from people over 70 and of the accepted applications, 62.6% were from people in need of

home care (Ferring and Weber, 2005).


The Law of 19 June 1998 (“Assurance Dépendance”) led to the introduction of an obligatory dependency

insurance on 1 January 1999 (sometimes referred to as long-term care insurance or “LTCI”). This covers

expenses linked to the care of elderly residents in old people’s homes or assistance at home.


The dependency insurance is financed by people (whether they are Luxembourg residents or simply

commuters from the surrounding countries) who contribute to the Luxembourg sickness insurance. For the

monthly contribution, each person pays 1% of their total gross income (less a quarter of the minimum social

salary). There are plans to increase this to 1.4% in the near future (Di Bartolomeo, 2006). For Luxembourg

residents, investments, rental and other sources of income are also included in the calculation for annual

contributions.

Before home care services are provided, a person must have a needs assessment which involves a medical

examination and an evaluation of their level of dependency. This is organised by the “Cellule d’Evaluation et

d’Orientation” (CEO) which is comprised of a multidisciplinary team under the authority of the Ministry of

Social Security. According to the dependency insurance law, a person is considered as dependent if due to a

disease or a physical or mental disability, he or she regularly needs a considerable amount of assistance from a

third party in order to carry out basic daily tasks (i.e. at least 3.5 hours per week).

Deliverable 2.1


The final decision concerning entitlement to services and the amount of services to be provided is taken by the

Union of Sickness Funds (“Union des caisses de maladie”) based on information about the assessment carried

out by the CEO. The Union of Sickness Funds is responsible for:

1. the individual classification of dependency, as well as the attribution, reduction and suppression of the

different benefits and services;

2. the payment of nursing services, the elaboration of nursing contracts and the negotiation of the

monetary value of nursing services;

3. negotiation with service providers concerning the provision of nursing aids (Ferring and Weber, 2005).

Dependent people receive a nursing allowance of € 23.85 per hour which can be used to finance informal care

e.g. provided by a relative, friend or significant other. However, if the estimated amount of care to be provided

is between 7 and 14 hours per week, at least half of the services must be provided by help networks e.g.

“Hëllef Doheem”. If the person is in need of more than 14 hours of services per week, such services must be

completely provided by the help networks (Ferring and Weber, 2005).

In addition to services provided by informal carers and the established help networks, there are about 23

associations, registered with the Ministry of Family Affairs, which operate on a voluntary basis.


The person appointed to provide care is responsible for assisting and supporting the dependent person in

performing basic acts of living or partially or totally performing these acts for the dependant person. This could

include:

Deliverable 2.1


26.1.1 References

Di Bartolomeo, M. (2006): information given in speech at the “Cross Atlantic Exchange to advance long-term

care” conference held on 13 September 2006 in Bruxelles (organised by AARP and the European Commission)

EFILWC (2002), Dependency insurance in Luxembourg,www.eurofound.ie/living/socpub_cstudies/lu1.htm

Ferring, D. and Weber, G. (2005), National Background Report for Luxembourg, EUROFAMCARE.

http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_luxembourg_rc1_a4.pdf

Hartmann-Hirsch, C. et al. (1999), L’Assurance Dépendance; guide pratique, Ministère de la Sécurité Sociale

Horsburgh & Co. S.A. (2005), Assurance Dépendance,www.horsburgh.lu/assurdepend.html

27 OLDER PERSONS HOMECARE IN MALTA

27.1 Introduction to older persons homecare service in Malta

27.1.1 Demographic data

In 2014 Maltese population was 427,40029 and the life expectancy at birth 81.730. The life expectancy of people

over 65 is 20.07 in 2010 and 20.48 in 201431. The average population density per km2 was 1295.3 in 2010 and

1335.5 in 201432 and as a result Malta has the highest population density in Europe. The risk of poverty of the

Maltese population over 65 is very low. The following table represents Maltese population in 2010 by age and

its projections in 2025 and 206033.

Figure 25: Malta’s present and projected population pyramids (2010, 2025, 2060)

27.1.2 Health and home care in Malta: organization and governance 29

http://data.worldbank.org/country/malta 30

http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators 31

http://data.euro.who.int/hfadb/ 32

http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators 33

National Strategic Policy for Active Ageing: Malta 2014-2020, page 13.

Deliverable 2.1


Health services are highly advanced and all residents access to the different services provided by the public

centers and hospitals, such as: personal health services, rehabilitative, curative, diagnostic and preventive

services. Nevertheless, the share of GDP allocated to social security benefits is lower than the EU27 average.34

The Maltese system is public and centralized at the Government level in terms of governance, regulation

provision and financing even if the recent reforms, in particular the Health Act, provides directions to work

towards controlled decentralization and autonomy and the involvement of local government in community

health care35.

The Ministry for Health and the Ministry for the Family and Social Solidarity are respectively responsible for

the organization and governance of the health and home care services. In particular, the Ministry for Health is

competent in subject of: provision of health services, health services regulation and standards and provision of

occupational health and safety. The Ministry for the Family and Social Solidarity has the competence in theme

of: social policy and policy relating to the child, the family and people with a disability, elderly people and

community care, social housing, social security, pensions and solidarity services. For what concerns the

financing of the services, the Ministry for Finance prepares the government budget, collects and allocates

taxes and revenue while the two Ministries are responsible for the financing and provision of services within

their portfolios. Finally, the organization and the governance includes other actors such as some government

ministries, the Foundation of Medical Services, government commissions, agencies, boards and committees,

professional regulatory bodies and professional groups, private and voluntary sectors, the Church and the

general public. In particular, the public health-care system provides the health services and the private sector

complements them, such as in the area of the primary health care and of the long-term and chronic care. The

public health-care system provides services to all persons residing in Malta covered by the Maltese social

security legislation and to groups such as irregular immigrants and foreign workers who have valid work

permits, without any user charges or co-payments for health services. The public health service and private

general practitioners (GPs) provide primary health-care services. Specialized public hospitals provide

secondary and tertiary care and the main acute general services are provided by one teaching hospital

incorporating all specialized, ambulatory, inpatient care and intensive-care services36.

In 2011 the first Commissioner for Older Persons has been appointed. Moreover, in 2013, the Department for

the Elderly and Community has been moved by the Health Ministry to the Ministry for the Family and Social

Solidarity. For some experts, this move implies a shift from a medical to a social policy and as a result the

incorporation of the social work services. Nevertheless, the Department has only five social workers mainly

dedicated to the assessment of applications for residential, day or home care services37.

In the field of Long-Term Care, the services are provided by the state, the Church and the private sector. The

first Elderly Care Department was established in 1988. At the present time, the Department for the Elderly and

Community offers services to support elderly people such as: home care help, telecare, meals on wheels,

34

Home Care across Europe, Case studies, Edited by Nadine Genet, Wienke Boerma, Madelon Kroneman, Allen Hutchinson, Richard B Saltman, European Observatory on Health Systems and Policies, World Health Organization, 2013, page 188. 35

Malta Health system review, Vol. 16 No. 1 2014, Health Systems in Transition, European Observatory on Health Systems and Policies, Natasha Azzopardi Muscat, Neville Calleja, Antoinette Calleja, Jonathan Cylus, page 19. 36

Health Systems in Transition, Malta Health system review, Natasha Azzopardi Muscat, Neville Calleja, Antoinette Calleja, Jonathan Cylus, European Observatory on Health Systems and Policies, 2014, pages 13-16. 37

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis, Charles Pace, Sue Vella & Sophia F. Dziegielewski, Journal of Social Service Research, 2016, 42:2, 263-279, DOI: 10.1080/01488376.2015.1129018, 2016, page 271.

Deliverable 2.1


handyman service and incontinence service. Moreover, it also manages day-care centres within the

community. Elderly residents residing in state homes contribute 60% of their total income and residents at St

Vincent De Paul contribute 80% of their income. The largest care home for old people is the St Vincent De Paul

with its 1126 beds, 7 of which are respite beds38.

Several services concern the over 75 with disability: outpatient clinics and hospitals, residential homes and

community services. These services include domestic aid, personal care, day care, public residential homes for

elderly, the Handyman Service, the Incontinent Service, social work units, long-term health facilities.

27.1.2 Home care in Malta policy In Malta, the Social Security Act contains the main legislation on home care39.

Moreover, as other European Union Member States, Malta has defined a specific plan, named “National

Strategic Policy for Active Ageing: Malta 2014-2020” that also aims at reducing the need for institutionalised

care providing. The strategy describes Maltese stance and policy directives in the field of population ageing,

encouraging older persons to take responsibility for their own quality of life and well-being. It includes seven

key principles: “First, activity refers to all meaningful pursuits which contribute to the well-being of older

persons. Second, active ageing policies must involve all older persons including those who are relatively frail

and dependent. Third, active ageing is primarily a preventive concept that focuses on the avoidance of ill-

health and social exclusion in later life. Fourth, active ageing is intergenerational, with sectors of civil society

being stakeholders in this undertaking. Fifth, policies premised on active ageing embody both rights and

obligations. Sixth, strategies on active ageing are participative and empowering. Seventh, active ageing is

sensitive to national and cultural diversity”. The directives of the Maltese strategy mainly concern: the active

participation in the labour market, the participation in society and the independent living. Regarding the

independent living, the Strategy focuses on some subjects: the health prevention and promotion, the acute

and geriatric rehabilitation, the mental health and well-being, the community care services, the age-friendly

communities, the dementia-friendly communities and services, the maximising autonomy in long-term care,

the protection from abuse and the end-of-life care. The Strategy focuses on the community care services in

different parts providing a set of interesting policy recommendations40.

As previously remembered, in 2013, the Department for the Elderly and Community has been moved by the

Health Ministry to the Ministry for the Family and Social Solidarity. For some experts, this move implies a shift

from a medical to a social policy and as a result the incorporation of the social work services. Nevertheless, the

Department has only five social workers mainly dedicated to the assessment of applications for residential,

day or home care services41.

The Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing (in the following the

Parliamentary Secretariat) provides community Services to Older Persons (60 plus) in Partnership with Local

Councils. These services include Day Centres Services, Respite Care Services (beds), and Night Shelter Services.

Recently, the Parliamentary Secretariat has issued an invitation to targets Local Councils to explore the

38

Malta Health system review, Vol. 16 No. 1 2014, Health Systems in Transition, European Observatory on Health Systems and Policies, Natasha Azzopardi Muscat, Neville Calleja, Antoinette Calleja, Jonathan Cylus, pages 64-65. 39

Social Security Act, Chapter 318, 1st January, 1987 available at http://justiceservices.gov.mt/ 40

See the National Strategic Policy for Active Ageing: Malta 2014-2020. 41

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis, Charles Pace, Sue Vella & Sophia F. Dziegielewski, Journal of Social Service Research, 2016, 42:2, 263-279, DOI: 10.1080/01488376.2015.1129018, 2016, page 271.

Deliverable 2.1


possibility that more services are initiated through Public-Private Partnerships, as the non-government sector

can play a key role in the future. A mixed financing system is able to continue providing an increasing number

of older persons with the optimal level of caring services. As a result, Local Councils have been invited to

communicate their proposal describing their available resources, including edifices and human resources as

well as proposed forms of assistance they would require from the Parliamentary Secretariat42.

The Department for the Elderly and Community offers services of residential cares in various facilities and also

residential care in private homes under the Public Private Partnership Scheme. The services aim to support the

elderly to continue living in the community and include: Telecare Service, CommCare, telephone rebate

scheme, incontinence service, Zejtun night shelter, handyman service, Home Help service and Day Centres. It

is also responsible for the issue of the Kartanzjan documents. According to the objective of the project, we are

going to describe the services for the elderly relevant for Malta to help the elderly to live at home.

Kartanzjan

According to the Identity Card Act, Cap. 258, the Electoral Office issues the Kartanzjan card to all the holder of

a Maltese Identity Card upon his or her 60th birthday. It entitles its holder to obtain certain benefits in terms

of rebates and concessions. Moreover, upon the 75th birthday, it is issued the second type of Kartanzjan and

the holders are entitled to the additional benefit such as being granted preference at queues at hospital and

health centres43.

Telecare Service Plus

The Telecare Plus service allows the communication with the Call Centre 24 Hours a day, 7 days a week and

enables older adults, disabled persons and those with special needs to call for assistance when required,

encouraging them to continue living in their own home and also reassuring the subscriber’s carers and

relatives. Moreover, the subscriber is able to call for help from the police, health doctors or relatives. The

eligible persons for this service are: elderly couples/persons living alone, aged sixty years and over, disabled

persons and those with special needs and, finally, persons of any age with chronic systemic illnesses, living

alone and not gainfully occupied. The service is highly subsidized and only few applicants pay the Telecare Plus

rental fee, which is €4 a month incl. VAT. The subscriber is also given a pendant with an emergency button and

in case of emergency an alarm could be submitted to the call centre. The Call Centre operators organize aid up

till first aid is present. Moreover, the service offers different kind of assistances such as an integrated system

which reminds to take medicines, messages “I’m OK” towards relatives, etc44.

CommCare Unit

CommCare Unit acts as a bridge between the health and social care services and ensures that everybody,

receiving care in the community area, is appropriately cared for. This unit delivers care applying an

interdisciplinary approach; in fact, the team generally comprises nurses, a physiotherapist, an occupational

therapist, a social worker, personal carers and administrative staff.45 In particular, the CommCare Unit acts as a

regulator for community nursing care, coordinates services and manages care plans for patients on an

individual basis, maintains and continues to develop an interdisciplinary approach in case management

42

http://www.activeageing.gov.mt/en/Pages/Invitation-for-Collaboration-with-Local-Councils.aspx 43

http://www.activeageing.gov.mt/en/Pages/Kartanzjan/Kartanzjan.aspx 44 http://www.activeageing.gov.mt/en/Pages/Telecare/Telecare.aspx 45

http://www.activeageing.gov.mt/en/Pages/CommCare-Unit/CommCare-Unit.aspx

Deliverable 2.1


incorporating both health and social aspects and analyses data collected to address current needs and plan for

future developments. The individuals eligible are the individuals whose needs require that care is delivered

within their own home, the ones whose independence will be at risk if they are not supported within the

community and those who are unable to leave their home due to environmental barriers. All the Government

and voluntary entities can receive requests and referrals. The CommCare team makes an initial assessment

over the phone and referred for home visits. First time home visits are carried out by one or more members of

the team. These visits determine the contents of the assistance and an individual care plan. After an evaluation

of needs is done to initiate care and any needed services delivery. People may be referred by the CommCare

team to the CommCare Outreach Programme to maximise the independence and ability to live in the

community, in his or her own home setting, through a structured plan of intervention. Individuals may also be

referred to other community services, such as the community nursing and midwifery care provided all over the

Maltese Islands through Health Mark, through the government health service. Health mark employs qualified

nurses supported by carers, providing general nursing services such as general care of patients, blanket baths,

enemas, wash-outs, wound care, catheterization and treatment for diabetes46.

Social Work Unit

The Social Work Unit deals with social casework: in particular, it provides psychological support, guidance and

assistance, assessments for residential homes and home care help service, liaises with the geriatric, general

rehabilitation hospitals, the health Department, Police, Local Councils, Parish Priests and other community

organizations, facilitates self-help management and develops action plans. The eligible persons are: older

persons living alone with a high level of dependency; those who are of an advanced age; older persons

suspected to be suffering from physical, psychological, social or financial abuse; older demented or

disorientated persons; older persons living in squalor or homeless elderly people. The service is free of

administrative fees47.

Day Centres

The day centre service helps to prevent older persons’ social isolation and feeling of loneliness and to reduce

the social interaction difficulties. It also motivates the elderly to participate to day centre activities and offers

respite for relatives and carers. The persons eligible to this service are those over 60 years old, elderly persons

living alone, those who are not engaged in social activities and are at risk when spending long hours on their

own. For this service it is required to pay a minimal fee, from Eur 2.33 to Eur 5.82, a month. The frequency to

attend the day centre depends on the capacity of the particular day centre48.

Night Shelter

Introduced by the Department for the Elderly and Community Care in collaboration with the Jesus of Nazareth

Sisters of Zejtun, the Night Shelter service focuses on the elderly persons who live alone to offer a secure and

protective environment. The applicants may be: for Zejtun Night Shelter, elderly females aged 60 and over

living alone; for Luqa & Mellieħa Night Shelters, males and females; those who lead an independent life; those

not having any other medical condition which may rise any problems with the rest of the residents using the

Night Shelter. The fee amounts to 2 Euro per night. The facilities offered at the Night Shelters are: the use of a

46

http://www.activeageing.gov.mt/en/Pages/CommCare-Unit/CommCare-Unit.aspx 47

http://www.activeageing.gov.mt/en/Pages/Social-Work/Social-Work.aspx 48

http://www.activeageing.gov.mt/en/Pages/Day-Centres/Day-Centres.aspx

Deliverable 2.1


bedroom, a bathroom, a living room and a kitchen. The opening hours are: winter time from 5.00pm till

8.00am and summer time from 7.00pm till 8.00am49.

Handyman Service

This service helps older adults and persons with special needs to continue living independently in their own

home, offering a range of around seventy repair jobs (from electricity repairs to plumbing, carpentry and

transport of items, etc.). All senior citizens are eligible and particular: the persons with a Pink form issued by

the Department of Social Security (service free of charge); those without a pink form (against a payment); and

persons who hold the special identity card issued by the National Commission for Disabled Persons. The rates

vary according to the job required. The service is also available for some centres. The client pays the

handyman and the latter issues a temporary receipt while an official receipt is issued from the Department for

the Elderly and Community Care. Nevertheless, both Pink Cardholders and Non-Pink Cardholders must provide

the materials at their own cost. A job is carried out within five days50.

Home Help

The service offers non nursing, personal help and light domestic work to persons with special needs to aid

beneficiaries to keep on living in their community independently and to provide respite for informal carers.

The applicants who are sixty years and over are eligible to apply and must contact the Home Help Section at

the Department for the Elderly and Community Care. Also persons with special needs under sixty years of age

can apply. Finally, all the terminally ill, irrelevant of their age, may also apply. The necessary documents are:

the specific application, duly filled with the particulars of the applicant, a medical report and, if available, the

copies of recent medical reports or hospital discharge letters. The programmes are customized according to

individual needs and a programme is defined: as a result, the number of hours per week may change. The

service is free from administrative fees. However, there is a nominal fee per week for every person benefiting

from the service. Beneficiaries may request the preparation of meals at an additional fee51

Meals on Wheels

The Meals on Wheels service supports elderly persons (and others) that can’t prepare their meal. The non-

governmental organization “Maltese Cross Corps” in collaboration with the Department for the Elderly and

Community Care provide the cooked meal. People over sixty years and people with disability are eligible. The

interested applicants must contact directly the Meals on Wheels Service and fill the application form. Each

meal costs Eur 2.213 and consists of two courses, a roll and a dessert, served in a foil receptacle and delivered

in a polystyrene container. The meal is carried out between 9am and 12pm and it is effected in all localities52.

Other services

Incontinence Service

The service alleviates the psychological problem to which a person may be subjected, provides heavily

subsidized diapers to decrease the physical and financial strain and finally supports incontinent persons and

older adults to continue living in their community. To be eligible, the applicant must: be in possession of the

49

http://www.activeageing.gov.mt/en/Pages/Night-Shelter/Night-Shelter.aspx 50

http://www.activeageing.gov.mt/en/Pages/Handyman-Service/Handyman-Service.aspx 51

http://www.activeageing.gov.mt/en/Pages/Home%20Help/Home-Help.aspx 52

http://www.activeageing.gov.mt/en/Pages/Meals-on-Wheels/Meals-on-Wheels.aspx

Deliverable 2.1


special identity card issued by the National Commission for Disabled Persons or be over sixty years of age and

suffers from incontinency. The service does not foresee the payment of administrative fees. The responsible

unit is the Incontinence Service and a medical doctor defines the number of diapers needed. Then, according

to the applicant’s situation a ticket voucher (monthly) or a Green Card (two years) are issued53.

National Dementia Strategy and National Dementia Helpline

Dementia is a progressive illness concerning brain diseases and causing problems such as difficulties with

memory, thinking, communication skills and behaviour and the age is the most important risk factor in

developing it. As a result, patients become more in need of help and support in performing everyday activities.

In April 2015, the National Strategy for Dementia in the Maltese Islands (2015-2023) was officially launched by

the Parliamentary Secretary. It sets out a work programme to enhance the quality of life of individuals with

dementia, their caregivers and family members through intervention streams in different priority areas. The

number of individuals with dementia is increasing: in 2015 was estimated to be 6,071, 1.5 per cent of the

population, and in 2050 it is projected to reach 3.5 per cent. As a result, the demand on the health and social

care services will growth too, as the most of the care is provided by family members who act as main

caregivers54.

The National Dementia Helpline is the first initiative of the National Strategy on Dementia to aid persons with

dementia and their families, 24 hours a day by calling the number 1771. It can assist 6,000 individuals and their

families. The helpline is managed by four nurses specifically trained to provide instant help in cases of

emergency as well as to give information on the services. Finally, the volunteers of the non-government entity,

Malta Dementia Society (MDS), work with these people offering help to these persons with a limited

helpline55.Other initiatives concern the Dementia Intervention Teams that will be active very soon to provide

a high level service in all localities and training for informal carers and the day centres made specifically for

those who suffer from dementia. At present, the Dementia Centre at St. Vincent De Paul is a day Centre that

opens seven days a week including Public Holidays, from 6.30am till 5.00pm, and offers a safe and stimulating

environment, professional trained staff, to maintain an optimal quality of care for individuals with Dementia

who still live in the community56.

beActive – Active Ageing Project

The pilot project beActive, promoted by the Parliamentary Secretariat and aimed to promote new means of

active ageing in an adapted environment and with professional trainers, has been held on a permanent basis.

More than 200 people have participated. Applicants should be over 60 years of age57.

LifeLong Learning Hubs

The service is held in Day Centres for the Elderly (transformed in Life Long Learning Hubs) and offers several

informative sessions and learning opportunities58.

53

http://www.activeageing.gov.mt/en/Pages/Incontinence-Service/Incontinence-Service.aspx 54

http://www.activeageing.gov.mt/en/Pages/National-Dementia-Strategy.aspx and http://www.activeageing.gov.mt/en/Pages/Dementia/Dementia.aspx 55

http://www.activeageing.gov.mt/en/Pages/National-Dementia-Helpline.aspx 56

http://www.activeageing.gov.mt/en/Pages/Dementia-Centre-at-St--Vincent-De-Paul-.aspx 57

http://www.activeageing.gov.mt/en/Pages/beActive-%E2%80%93-Active-Ageing-Project.aspx 58

http://www.activeageing.gov.mt/en/Pages/LifeLong%20Learning%20Hubs/LifeLong-Learning-Hubs.aspx

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27.2 HHCP involved in older persons homecare service in Malta: roles and competences

The HHCP mainly involved in older persons homecare service in Malta can be represented by the CommCare team ones that include: nurses, physiotherapist,

occupational therapist, social workers and personal carers. In fact, the team has an interdisciplinary approach and supports individuals remaining in the

community.

In the recent years, the University of Malta, Faculty of Health Sciences with its 12 Departments, offers degree programmes leading to a health care profession on

nursing, occupational therapy and physiotherapy. Moreover, the Faculty is also responsible for the running of Continuing Professional Development courses for

registered practitioners.

Moreover, the Faculty for Social Wellbeing offers the programme to achieve the Bachelor of Arts (Honours) in Social Work.

Nurse, physiotherapist, occupational therapist and social worker professions are regulated by law that establishes ad hoc professional council, boards, etc59.

NURSES

Malta has a specific legislation that regulates the practice of health care professions: the Health Care Professions Act, Cap. 464. Obviously this Act considers the

nurses (and midwives) and foresees that the Register of Nurse is kept by the Council for Nurses and Midwives. The Register consists of parts:

• Part I in respect of first level registered nurses;

• Part II in respect of second level registered nurses; and

• Special Parts in respect of nurses trained in the different special areas recognized by the Council for Nurses and Midwives60.

Moreover, the COUNCIL regulates the Nursing and Midwifery Professions and the entry to and exit from it. Finally, the Council is responsible for the upholding of

high professional and educational standards for both professions61.

About nurse training, the University of Malta, Faculty of Health Sciences offer different courses and related certificates, diploma and academic degrees: 59

https://ncfhe.gov.mt/en/services/Documents/Mutual%20Recognition/Designated%20Authorities.pdf 60

Health Care Professions Act, Cap. 464, Part IV, https://health.gov.mt/en/regcounc/cnm/Pages/cnm.aspx 61

https://health.gov.mt/en/regcounc/cnm/Pages/cnm.aspx

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Certificate in Clinical Nursing Practice (Adult Cancer Care) (Part-Time Evening), Certificate in Clinical Nursing Practice (Emergency Nursing) (Part-Time Evening),

Certificate in Clinical Nursing Practice (Elderly Care) (Part-Time Evening), Certificate in Clinical Nursing Practice (Theatre Nursing) (Part-Time Evening), Diploma in

Health Science (Nursing Studies) (Full-Time), Preparatory Course for the Higher Diploma in Health Science (Nursing Studies) (Full-Time), Higher Diploma in Health

Science (Nursing Studies) (Full-Time), Bachelor of Science (Honours) Community Nursing (Part-Time Day), Bachelor of Science (Honours) Health Science (Part-Time

Distance Learning), Bachelor of Science (Honours) in Nursing (Full-Time), Master of Science in Nursing (Part-Time Day) (Taught and Research, Mainly Taught),

Master of Science in Nursing (Full-Time) (Mainly by Research), Master of Science in Nursing (Part-Time Day) (Mainly by Research).

In the following tables, the focus concerns:

• Diploma in Health Science (Nursing Studies) (Full-Time),

• Certificate in Clinical Nursing Practice (Elderly Care) (Part-Time Evening),

• Bachelor of Science (Honours) Community Nursing (Part-Time Day).

NURSE - Level 5 of the NQFL62

The Diploma in Health Science (Nursing Studies) regards a Short Cycle of Qualification. It corresponds to the Level 5 of the National Qualification Framework

Level. The course lasts 3 semesters and the attendance is full-time. The ECTS credits amounts to 90. The applicants must have obtained the credits of the

Preparatory Course (of three semesters of full-time study) prior to commence the Course. The completion of the studies leads to the registration on the general

section of the nurse register of the Nursing and Midwifery Council of Malta. Moreover, the diplomates can join part-time programmes leading to a Bachelor’s

degree. Finally, the programme conforms to the European Union Directives on Nursing Education and secures recognition as a first level nurse across EU member

states.

OCCUPATION - HCCP ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Clinical areas: Community and home care,

Quality and appropriate nursing care in a variety of

To practice in a professional, accountable manner through critical thinking, knowledge and reflection

To use interpersonal, listening and communication skills To work under pressure

To be competent, caring and professional practitioners, To draw upon the various types

62

http://www.um.edu.mt/healthsciences/overview/UCCNPEDCPTE-2016-7-O

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School nursing, Acute hospital settings, Long-term and rehabilitation settings

health care settings To know the theories and concepts that underpin and challenge nursing practice To know skills and attitudes central to nursing to function effectively, as a professional nurse To have interpersonal skills to be key members of the multidisciplinary team within any health care setting

coping well in stressful situations To have a caring attitude To uphold professional and personal integrity To be flexible about working hours To have a good background in the sciences, particularly in biology

of knowledge, the appropriate skills and understanding of an individual’s personal wishes To provide the highest possible standard of care To be able to show respect to clients and their colleagues


The Certificate in Clinical Nursing Practice (Elderly Care), an undergraduate certificate programme, focuses on specific fields of practice; it regards a Short Cycle of

Qualification. It corresponds to the Level 5 of the National Qualification Framework Level. The course lasts 2 semesters and the attendance is part-time evening.

The ECTS credits amounts to 30 at levels 3 and 4. The programme is organised according to clinical pathways. All State Registered Nurses may apply, irrespective of

their academic qualifications: nurses who have either a traditional diploma or a diploma from the University of Malta, or an EN-SRN conversion certificate. Nurses

with bachelors, masters and doctoral degrees are also eligible to apply. The Applicants must be in possession of the following qualifications: a diploma in Nursing

awarded by the University of Malta or a professional qualification deemed by Senate to be equivalent to the qualification. The successful completion renders a

candidate eligible for application for enrollment on to bachelor's programmes of studies.


(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Clinical Nursing Practice (Elderly Care)

Complex, highly skilled activity that requires to work in a multidisciplinary team

To develop the breath and depth of knowledge, skills and attitudes to be able to deliver, analyze and evaluate the holistic care of patients and their families To have in-depth knowledge and skills

To prioritize the delivery of care for patients with various levels of health care needs To show an understanding of a range of assessment tools and

To demonstrate in-depth knowledge and skills together with an ability to reflect critically on work To be able to provide the highest

63


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To use knowledge of pathophysiology to make accurate interpretation of physical assessment data To assess the psychological and social needs of patients To deepen knowledge and skill relating to clinical speciality

choice of referral pathways To integrate information which addresses complex health related issues To integrate critical thinking skills in addressing complex health related issues To develop reflective skills To exercise communication skills To improve academic writing skills To manage information through effective retrieval, interpretation and utilization To demonstrate a commitment to professional development

possible standard of care Personal organization and responsibility (including time management)


The Bachelor of Science (Honours) in Community Nursing regards the First Cycle of level qualification. It corresponds to the Level 6 of the National Qualification

Framework Level. The course lasts 3 years and the attendance is part-time day. The ECTS credits amounts to 120. Community care is one of the most dynamic and

challenging areas in health care. Community nurses work with people and their families and in settings as diverse as homes, health centres, work places and

schools, helping individuals and groups with extensively varied health needs. The community nurse is provided with unique opportunities to deliver effective,

holistic care. As a result, community nurses face the challenge of working on their own and are members of interdisciplinary teams, often acting as coordinators of

comprehensive programmes of care. For these reasons, community nurses receive specialized training for this specialized role. Registered state nurses who are

traditionally trained and diploma trained professionals may apply. Preference is given to nurses already working within community settings. Graduates obtain a

degree qualification and a specialization in community nursing.

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(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Clinical areas: Community and home care, School nursing, Acute hospital settings, Long-term and rehabilitation settings

To work in team, with people and their families and in diverse settings To act as coordinator of comprehensive programmes of care

To deliver effective, holistic care To work on their own and in interdisciplinary teams

To face the challenge of working on their own and in interdisciplinary teams, often acting as coordinators of comprehensive programmes of care To have an interdisciplinary approach To help individuals and groups with extensively varied health needs

To be able to coordinate To play a specialized role

PHYSIOTHERAPIST65

The Bachelor of Science (Honours) in Physiotherapy regards First Cycle of Qualification. It corresponds to the Level 6 of the National Qualification Framework

Level. The course lasts 4 years and the attendance is full-time. The ECTS credits amounts to 240. As the number of students is limited, applicants must satisfy

admission and progession requirements (General Entry Requirements for admission, namely, the Matriculation Certificate and Secondary Education Certificate

passes at Grade 5 or better in Maltese, English Language and Mathematics and Special Course Requirements, a pass at Advanced Level at Grade C or better in

Biology and a pass at Intermediate Level in Physics). The first three years of the course are mainly academic, while the final year is dedicated solely to supervised

clinical practice. The completion of the studies make the candidates eligible to apply for registration with the Council for the Professions Complementary to

Medicine both locally and in Europe especially the United Kingdom and, once registered, the physiotherapist can look forward to state employment, within the

Department of Health, Care of the Elderly, and the Department of Education, as well as employment in the private sector. Moreover, career opportunities exist in

academia where access to Masters’ or Doctoral programmes are available and specialization.

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(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Clinical areas Diagnostic, ameliorative and restorative roles

High level of theoretical and factual knowledge and practical ability Knowledge of Anatomy, Biomedical Sciences and Physical Science Examination and assessment of patients referred for treatment Diseases processes Technical competence Selection of appropriate intervention

To prevent, diagnose and treat any condition that influences the physical function and performance of the body

To be patient, sympathetic and firm to help patients To encourage, reassure and persuade patients of the benefits of their treatment To be skilled in listening, explaining and report writing

OCCUPATIONAL THERAPIST66

The Bachelor of Science (Honours) in Occupational Therapy regards First Cycle of Qualification. It corresponds to the Level 6 of the National Qualification

Framework Level. The course lasts 4 years and the attendance is full-time. The ECTS credits amounts to 240.

As the number of students is limited, applicants must satisfy the General Entry Requirements for admission, namely, the Matriculation Certificate and Secondary

Education Certificate passes at Grade 5 or better in Maltese, English Language and Mathematics and the Special Course Requirements, a pass at Advanced Level at

Grade C or better in Biology.

The completion of the studies make the candidates eligible to apply for registration with the Council of Professions Complementary to Medicine and entry to the

occupational therapy profession and to register with professional bodies within EU member States. Furthermore, the programme of studies is recognised by the

World Federation of Occupational Therapists. Occupational therapists can acquire positions in all parts of the health sector in Malta (as well as overseas) and

suitable employment may be found with the local health services, specialist health services, company health services, schools, NGOs as well as in private

institutions. Opportunities for professional development and specialization exist too. This programme also provides a basis for Masters’ level degree studies.

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(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Clinical areas: home, work-place, school or even the community

To empower individuals who have sustained an injury, disease or developmental delay to achieve their maximal level of independence in daily life activities, by the use of occupation, purposeful activity, exercise, the modification of the environment and education Health promotion prevention of health problems in those individuals who may be at risk

To work with all age groups To assess and manage a range of client-groups

To help to establish the baseline capabilities of the client To modify the environment which may involve adjustments to the home, work-place, school or even the community to allow individuals with disabilities to function optimally in their immediate surroundings To draw up a comprehensive treatment plan To improve the function of the components involved in the carrying out of occupations (such as strength, movement, coordination, endurance, perception and memory) To modify the skills involved in the carrying out of such occupations Education of the family, carers or co-workers

To develop a range of professional behaviors of relevance to this discipline To be judicious users to promote the adoption of rationale-based methods in all professional endeavors and life-long learning To evaluate Information concerning physical abilities, perceptual, cognitive, psychosocial functioning, environmental aspects and occupational history To guide the client to adapt their habits, routines and lifestyles in order to help accommodate their level of function

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SOCIAL WORKER67

The Social Work Profession is regulated by “The Social Work Profession Act” that establishes the Social Work Profession Board whose members are appointed by

the Minister for the Family & Social Solidarity. The Board processes application for the Social Work Warrant. The Act establishes the “proficiency test” a test having

the aim of assessing a person’s ability to pursue the profession of social work in Malta and the Register of Social Worker, as it is a registered work. As a result,

“registered social worker” or “social worker” means a person who is registered in the official register of social workers kept by the Board and who has been

granted a warrant to practise the profession of social work, in accordance with article 6. Social work means the professional service that is performed to promote

or restore a mutually beneficial interaction between individuals as well as between individuals and society in order to improve the quality of life, by aiding persons

in receipt of such services to understand, resolve and prevent personal, interpersonal, family or social problems.

The social worker usually contacts the person concerned and sets an appointment. Then, according to the particular needs of each individual, the social worker

either visits the person in his/her own home, or the person visits the social worker at the Department. The social worker generally makes the assessment of each

individual’s situation. Moreover, if the old persons has a family, the social worker may conclude that the involvement of the family can be beneficial to the elderly

person, and if the elderly person is willing to involve his/her family, then the social worker makes contact with the family too.

The Bachelor of Arts (Honours) in Social Work regards First Cycle of Qualification. It corresponds to the Level 6 of the National Qualification Framework Level. The

course lasts 4 years and the attendance is full-time. The ECTS credits amounts to 240.

Generally, applicants must satisfy the General Entry Requirements for admission, namely, the Matriculation Certificate and Secondary Education Certificate passes

at Grade 5 or better in Maltese, English Language and Mathematics. The University programme is the only route in Malta through which individuals can enter the

social work profession, and therefore an important aim of the programme is to expose students to different social work settings in Malta and Gozo.

Persons who acquire a Bachelor of Arts (Honours) in Social can work within different social work settings: children and family settings, the drug and alcohol

sectors, the disability sector, community settings, health and mental health settings, working with the elderly, working with asylum seekers and refugees and

various residential settings. Moreover, the Bachelor of Arts (Honours) in Social Work allows students access to different Masters Programmes both locally and

overseas.

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(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

social work68

Professional service that is performed to promote or restore a mutually beneficial interaction between individuals as well as between individuals and society in order to improve the quality of life, by aiding persons in receipt of such services to understand, resolve and prevent personal, interpersonal, family or social problems

To practice the profession of social work To improve the quality of life of people To deliver services

To pursue the profession of social work To promote or restore a mutually beneficial interaction between individuals To promote or restore a mutually beneficial interaction between individuals and society To aid persons in receipt of such services to understand, resolve and prevent personal, interpersonal, family or social problems

To be equipped to work with vulnerable individuals in society To appreciate diversity and individuality To identify strengths in people and communities and to seek to develop those strengths and build on them

HOME HELPER69

Finally, in Malta there is the home helper, usually a part-time social assistants providing. This worker must have a clean conduct certificate by the police

authorities.

68

CHAPTER 468, SOCIAL WORK PROFESSION ACT, To make provision for the regulation of the social work profession and to, provide for matters connected therewith or ancillary thereto, 1st June, 2004, ACT XVII of 2003, as amended by Legal Notice 427 of 2007, available at https://sites.google.com/site/maswmalta/home/social-work-profession-board; and http://www.um.edu.mt/socialwellbeing/overview/UBAHSWKFTIII-2014-5-O 69

Home Care across Europe, Case studies, Edited by Nadine Genet, Wienke Boerma, Madelon Kroneman, Allen Hutchinson, Richard B Saltman, European Observatory on Health Systems and Policies, World Health Organization, 2013, page 190.

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(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

Home helps Domestic aid No required level of education - -

27.2.1 References

Social Security Act, Chapter 318, 1st January, 1987 available at http://justiceservices.gov.mt/

Health Care Professions Act, Cap. 464, Part IV, https://health.gov.mt/en/regcounc/cnm/Pages/cnm.aspx

CHAPTER 468, SOCIAL WORK PROFESSION ACT, To make provision for the regulation of the social work profession and to, provide for matters connected therewith

or ancillary thereto, 1st June, 2004, ACT XVII of 2003, as amended by Legal Notice 427 of 2007, available at:

https://sites.google.com/site/maswmalta/home/social-work-profession-board http://www.um.edu.mt/socialwellbeing/overview/UBAHSWKFTIII-2014-5-O

National Strategic Policy for Active Ageing: Malta 2014-2020

Home Care across Europe, Case studies, Edited by Nadine Genet, Wienke Boerma, Madelon Kroneman, Allen Hutchinson, Richard B Saltman, European

Observatory on Health Systems and Policies, World Health Organization, 2013

Health Systems in Transition, Malta Health system review, Natasha Azzopardi Muscat, Neville Calleja, Antoinette Calleja, Jonathan Cylus, European Observatory on

Health Systems and Policies, 2014

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis, Charles Pace, Sue Vella & Sophia F.

Dziegielewski, Journal of Social Service Research, 2016, 42:2, 263-279, DOI: 10.1080/01488376.2015.1129018, 2016

http://www.activeageing.gov.mt/en

https://ncfhe.gov.mt/en/services/Documents/Mutual%20Recognition/Designated%20Authorities.pdf

https://health.gov.mt/en/regcounc/cnm/Pages/cnm.aspx

http://www.um.edu.mt/healthsciences

http://www.um.edu.mt/socialwellbeing/overview/UBAHSWKFTIII-2014-5-O

http://data.worldbank.org/country/malta

http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators

http://data.euro.who.int/hfadb/

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28 OLDER PERSONS HOMECARE IN NETHERLANDS

28.1 Introduction to older persons homecare service in Netherlands

The Netherlands, even if is a small country, is densely populated with 16.7 million of inhabitants. Currently,

the proportion of persons with pensionable age (over 65 years) is below the European average, even if it is

expected to grow.

According to statistics, life expectancy is 81.12 years, 79.02 years for male and 83.34 for female70.

THE HEALTHCARE SYSTEM

The healthcare system of the Netherlands is governed by four basic healthcare-related acts/pillars that

represent the foundation of the Dutch healthcare system:

• the Health Insurance Act (Zorgverzekeringswet) - ZVW 2006,

• the Long-Term Care Act (Wet langdurige zorg) - WLZ 2015/2016,

• the Social Support Act (Wet maatschappelijke ondersteuning) - WMO 2015,

• the Youth Act (Jeugdwet) - 2015.

In addition, there are several general laws in place (including the Competition Act/Mededingingswet) and

other specific healthcare acts (e.g. the Care Institutions (Quality) Act).

The Health Insurance Act, for hospital care, and the Long-Term Care Act, for other types of care, account for

the bulk of the healthcare budget available in the Netherlands.

The Long-Term Care Act is a national act governing healthcare throughout the nation.

In implementing the Health Insurance Act, private health insurance companies play a key role in a system

based on “regulated competition” and a number of specific public requirements.

Other forms of care and support are provided by the Social Support Act and the Youth Act: the roughly 400

municipalities in the Netherlands are primarily responsible for enforcing these two acts.

In 2006, with the new Health Insurance Act, all residents of the Netherlands are entitled to a comprehensive

basic health insurance package. This act is implemented by private, competitive health insurers and healthcare

providers. The entry into force of this act has transformed the Dutch healthcare system from a supply-driven

to a demand-driven system.

The Dutch healthcare system is essentially a private system but the government plays a role of control in order

to protect the public interest and to guarantee the social nature of the health insurance.

The Dutch healthcare system is considered a “hybrid” from different points of view:

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Indexmundi 2014.

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• It is universal and inclusive, financed through general taxation, concerning the exceptional expenses

(long-term care, home care and residential care for the frail elderly and the physically and mentally

disabled).

• It is mutual because the standard curative care component is guaranteed by insurance companies; the

insurance is compulsory and the government supports low-income citizens.

• It is based on market rules because insurers are private organizations that operate in a competitive

environment.

The current structure of the system is designed by the reforms of 2006 and 2015, awarded by a ranking

system71, very generous and, also for this, very expensive.

HEALTH INSURANCE ACT

As already mentioned, the Dutch health insurance system combines elements of public and private insurance.

The central government is not directly involved in the actual implementation of the Health Insurance Act: the

procedures involved are determined by healthcare providers, health insurers and insured parties. This

structure ensures that healthcare providers have a great deal of freedom, while competition and market

forces create the incentives required to work efficiently and at a high quality level.

The government decides which types of care are included in the package and when this care should be

provided but the health insurers have to guarantee that the services included in the basic insurance package

are available to all their policyholders. It is possible to integrate with a supplemental insurance that is fully

private with no governmental rules.

The core set of health benefits that insurers are legally obliged to cover includes: services provided by GPs,

hospitals, specialists and midwives; prescriptions; maternity care; medical aids and devices; limited access to

therapeutic services and ambulatory mental health care; outpatient and inpatient mental health care for up to

a year; all dental care for under 18s; specialist dental care and dentures for adults. But there are some limits

on the services covered and certain treatments are excluded.

Therefore, health services are funded by a mix of obligatory social and private insurance, with additional co-

payments for long-term care.

LONG-TERM CARE, YOUTH HEALTH SERVICES AND SOCIAL SUPPORT

The recent reform of 2015 has introduced the Long Term Act, the Social Support Act and the Youth Act.

The aim of the reform is to keep people self-supported as long as possible. Most forms of non-residential care

will be transferred to the municipalities and added to the Social Support Act (WMO, in place since 2007).

Insurers will be responsible for home nursing.

The Long-Term Care Act is administered by special long-term care administrators at the behest of the central

government and, additionally, several other organisations are involved in its implementation.

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The local authorities are responsible for implementing the Social Support Act and the Youth Act – they provide

the support, assistance or care services or are supported by a healthcare provider.

The objective of these laws is to improve the quality of the care provided, promote an integrated approach,

and keep healthcare available and affordable in times of an ageing population and in which many people

suffer from chronic illnesses. A person that requires permanent supervision or 24-hour home is entitled to care

services under the Long-Term Care Act.

The first step of this reform process is the abrogation of the General Exceptional Medical Expenses Act.

Since 2015, all long-term care is provided under the Long-Term Care Act, which is strictly intended for the

most vulnerable categories of people.

In order to provide effective and high-quality care, the local authorities, being much closer to the people, are

responsible for administrating and implementing the Social Support Act and the Youth Act.

LONG-TERM CARE ACT

The 1st January 2015, the Long-Term Act entered into force replacing the General Exceptional Medical

Expenses Act: people who require permanent or 24-hour home care can take advantage of provisions under

this healthcare-act. With the reform The Exceptional Medical Expenses Act (ABWZ) is replaced by the Long-

term Care Act (WIz), for those who are unable to live at home.

Municipalities are responsible for home care and added to the pre-existing Social Support Act (Wmo), while

home nursing care is provided and organized by health care insurers.

In contrast with the past act, the Long-Term Act applies to a smaller group of people: most vulnerable groups

in the society, such as elderly people in advanced stages of dementia, people with serious physical or

intellectual disabilities, and people with long-term psychiatric disorders. The Centrum Indicatiestelling Zorg

(Care Assessment Agency) gives special-needs assessments to these people based on a national, standardised

format. Clients who have received a special-needs assessment can receive care either at home or in a care

home or similar facility.

The Long-Term Care Act is administered by special long-term care administrators at the behest of the central

government. These administrators have transferred the actual implementation to healthcare administration

offices that are designated in each region and which are closely affiliated to a health insurance company. They

organise the way the healthcare services are provided. The Long-Term Care Act is a compulsory health

insurance policy based on solidarity: anyone who pays income tax in the Netherlands pays premiums under

this act.

The main parties of the LTC are: clients and their representatives, the central government, the Care

Assessment Agency, the Dutch Healthcare Authority, the healthcare administration offices and the healthcare

providers.

If the clients are not satisfied with the care provided, they can choose another healthcare provider.

For those who want to manage their own healthcare needs, they have their “personal healthcare budget”.

They also have the option to submit a complaint to healthcare providers, the healthcare administration offices

and the Healthcare Inspectorate. The healthcare administration offices can set quality requirements when

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purchasing care under the Long-Term Care Act. In addition, they also check that the statements sent by the

health insurance companies match the care specified and the production agreements made.

The most common functions are:

• stay in a care facility: long-term stay, or being placed in a nursing home or designated, sheltered

accommodation for people with mental disabilities;

• personal care: assistance with washing, dressing, using the toilet, and eating and drinking;

• care that increases self-reliance: assistance in structuring the day, gaining greater control over one’s

life, and learning to perform household duties;

• nursing care: medical assistance, e.g. tending to wounds or administering injections;

• treatment under the Long-Term Care Act: a medical, paramedical or behavioural treatment which

helps with the recovery or improvement of a specific condition;

• transport to and from day programmes and day treatment: for people whose medical condition

prevents them from travelling to the day programme or day treatment independently.

The central government decides the types of care of the healthcare package under the Long-Term Care Act,

advised by the National Health Care Institute.

The healthcare administration office manages long-term care based on the special-needs assessment provided

by the Care Assessment Agency and discusses the situation with the client, who can then state their

preference for specific healthcare providers.

Alternatively, it is foreseen a personal healthcare budget, whereby people purchase and organise their own

healthcare. The client, together with the healthcare provider, draft a healthcare plan (for contracted care) or a

budget plan (for personal care), while the healthcare administration office informs the healthcare provider

that the care can be provided. The healthcare provider subsequently provides the care as agreed in the

healthcare plan or budget plan.

Funding healthcare under the Long-Term Care Act

A the Long-Term Care Act is a statutory social insurance, people pay an income-dependent premium through

their payroll tax. The amount of the premium is based on a fixed percentage (9.65%) of the income tax

(maximum amount of EUR 33,589).

The adult that wants to take advantage from the services offered by the Long-Term Care Act has to pay a

personal contribution, on the basis of the income and of the personal situation: if he/she lives at home or in a

care facility, is younger or older than 65, and is single, married or has a domestic partner.

The National Healthcare Institute is responsible to manage all the contributions that are deposited into the

Long-Term Care Fund. The central government tops up the fund using public funds if these funds are too low.

There are different forms of financing, depending on whether the client has opted:

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• for contracted care: a portion of the fund is transferred to the Central Administration Office (CAK). The

latter subsequently pays the healthcare providers at the behest of the healthcare administration

offices;

• personal healthcare budget: a portion of the fund is transferred to the Social Insurance Bank (Sociale

Verzekeringsbank/SVB), which manages the personal budgets for holders of such budgets. Those

responsible for organising healthcare based on a personal healthcare budget are entitled to special

drawing rights from the Social Insurance Bank: the invoices from the healthcare providers (up to a

maximum amount) are sent to the Social Insurance Bank, which pays these invoices.

SOCIAL SUPPORT ACT

The responsibility of providing support to people with disabilities has been transferred to the local authorities

with the Social Support Act 2015; including people with physical, mental or psychological disabilities, and

people with learning disabilities and the elderly.

The aim is to ensure that people can continue to be productive members of society and to enable them to

continue living at home. In addition, local authorities can provide sheltered accommodation and support to

people who have no other options or who are unable to live at home.

Local authorities support people who have difficulty participating in society or who cannot take care of

themselves or have a need for sheltered accommodation or support.

As it follows, a partial list of the services offered:

assistance and day programmes/daytime activity;

household support;

support by an informal carer;

volunteers;

a place in a sheltered environment (sheltered accommodation) for people with long-term

psychological disorders;

support for men, women and children who are victims of domestic violence;

social support, e.g. for people who are homeless;

financial support for people who incur significant additional expenses on account of their

chronic illness or condition.

HOME CARE IN THE NETHERLANDS

Home care has a long tradition in the Netherlands.

In 2006, government and stakeholders have developed a quality framework and norms for effective, efficient,

safe and client-centred home care72 and, in 2008, a governmental statement emphasised the importance of

transparency to the public, concerning the quality of care services73.

The Ministry of Health, Welfare and Sport (Ministry of VWS) is the main responsible for home care but

decision-making has been decentralised and directed by market force.

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There is near universal coverage, with fewer than 0.2 per cent uninsured74.

With regard to the allocation and contracting of nursing and personal care services at home, it has largely been

delegated to regional ‘care purchasing offices’ linked to the health insurance companies.

Municipalities are responsible for domestic aid and some technical aids and decide on the eligibility of these

services and negotiate prices with providers.

Home care services are provided by almost 1000 admitted private agencies operating locally or regionally in

competition75. The majority of the agencies are not-for-profit but the number of commercial agencies is

increasing.

The Netherlands has been the first country to establish a universal social insurance scheme for social care

needs in 1968.

With the 2015 reform, by its inclusion in the Health Insurance Act, home nursing is placed closer to other types

of primary care such as GP care. Health insurers become responsible for the whole medical domain, from

home nursing care to specialist hospital care. Home nurses combine their medical tasks with improving the

cohesion between prevention, care, well-being and housing. Recovery focussed mental care for adults (18 and

over) will also become the responsibility of health insurers.

The home care sector is considered an important source of employments in the Netherlands. Most numerous

are “domestic aids”. The majority works part-time and are female. In contrast, in the sector of home nursing

and personal care, permanent contracts are usual. Working conditions and payment for home helps and home

nurses are set at national level in collective labour agreements. Home nurses’ salaries are around the median

wage, while the salaries of home helps are below it.

BUURTZORG

The “Buurtzorg” phenomenon is an innovative approach in the Netherlands to deliver home care.

“Buurtzorg”, which means “care in the neighbourhood”, has originated in 2006 from staff’s dissatisfaction of

traditional home care organisations.

It has attracted international attention for its innovative use of independent nurse teams in delivering high-

quality, relatively low-cost care.

Buurtzorg was set-up by Jos de Blok (himself a former nurse) who envisaged a reformed district nursing system

in the Netherlands.

The model consists of small self-managing teams of a maximum of 12 professionals (comprising both nurses

and other allied health professionals) and aims for keeping organisational costs as low as possible, partially by

using ICT for the organisation and registration of care.

The aim of this approach is to engage three key national health priorities: health promotion, management of

conditions, and disease prevention.

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From the LTC process point of view, Buurtzorg introduces a built-in attempt to contact and integrate with

other local carers and with informal caregivers. Buurtzorg aims to deliver care to a client for as short a period

as possible, by involving and reinforcing the client’s resources.

Buurtzorg responds to the client’s care needs, tries to find solutions together with the client and his informal

carers and other formal carers involved, arranges things around care and social life and supports self-decision

of the client about what is necessary. This may explain the very high user satisfaction scores.

By mid-2010, teams were active in 250 locations nationwide. So far, data on patients’ satisfaction show that it

is extremely high. Also satisfaction of staff and of co-working GP’s is very high. At the same time indications

are that Buurtzorg home care is only about half as expensive as usual home care76.

KINDS OF CARE SERVICES AVAILABLE

Among the services that are offered by the home care system, below, a list of the main ones:

Home nursing (e.g. giving advice on how to cope with an illness, dressing wounds, administering medication),

personal care (e.g. assistance with dressing, bathing, personal hygiene, eating and drinking),

home help and housekeeping (e.g. cleaning, tidying and preparing meals),

day care,

respite care,

night care,

assistive devices. Concerning the domestic aid and supportive aids, the criteria for access to them are regulated by

municipalities: eligibility is independent of income but co-payments are general and dependent on income and

type of service. Also the personal situation is considered.

For an effective, efficient, safe and client-centred home care, a quality framework has been realized for the

nursing and caring sector. Measurable norms for the quality of care have been developed by stakeholders,

patient organisations and the Health Care Inspectorate (IGZ): the “Consumer Quality index for Home Care”

(CQI Home Care).

The IGZ is responsible for supervision on quality of services. In addition, home care agencies are annually

obliged to monitor and improve the quality of services and staff through reports.

Every two years, the home care agencies organise client evaluations and the municipalities have to assess the

clients’ satisfaction with domestic and services each year. The results of quality assessments are available on

the website http://www.kiesbeter.nl.

The individual providers are not obliged to be accredited, however, the agencies providing home nursing or

personal care, financed through the Exceptional Medical Expense Act, have to be registered.

The municipalities are the main actors specifically for domestic aid and supportive aids: they develop local

regulation on eligible services, organise needs assessment, finance providers and decide on prices and

76

Interlinks - Health systems and long-term care for older people in Europe. Modelling the interfaces and links between

prevention, rehabilitation, quality of services and informal care.

RCN Policy and International Department Policy Briefing 02/15 August 2015 The Buurtzorg Nederland (home care

provider) model

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providers. Part of domestic care (through the municipalities) is provided by home care agencies and part by

commercial cleaning enterprises. For the procurement of home care, municipalities are obliged to write a

tender, but they also have to observe that clients are able to make a choice between providers.

28.1.1 References

Indexmundi

Healthpowerhouse.com

The social care and health systems of nine countries - Commission on the Future of Health and Social Care in

England

Interlinks - Health systems and long-term care for older people in Europe. Modelling the interfaces and links

between prevention, rehabilitation, quality of services and informal care.

RCN Policy and International Department Policy Briefing 02/15 August 2015 The Buurtzorg Nederland (home

care provider) model

The social care and health systems of nine countries - Commission on the Future of Health and Social Care in

England

Healthcare in the Netherlands – Ministry of Public health, Welfare and Sport, January 2016

The Health Systems and Policy Monitor

Home care across Europe – Case studies

28.2 HHCP involved in older persons homecare service in Netherlands:


In the Netherlands, the education of the individual health carer, health and welfare assistant and care assistant

is regulated. The main figures that are involved in the provision of Dutch home care are the following:

• Nurses

• Carers: they work in nursing homes, home care and retirement homes.

• Administrative staff: the desk clerks make appointments with patients, provide general information, and receive visitors.

• Professionals from other disciplines: social workers, physiotherapists, psychiatrists, etc.

• Divers (medical) staff: surgical assistants, dietary aides, technicians, application manager, staff kitchen and transport service.

The Dutch nursing system is structured as follows:

- Level 1: Zorghulp (Auxiliary helps/Care assistant)

This person doesn't really help the patient himself, this person cooks, cleans, whatever that kind of

work.

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- Level 2: Helpende (Home helper/health and welfare assistant)

This person helps the staff with the care for the patient, they aren't allowed to do any reserved act like

medication or injections.

- Level 3: Verzorgende (Individual health carer) This person takes care of patients, give them their medications but can only do certain reserved acts.

The first three level can be classified as “caregivers” group.

All three levels are on the level of intermediate vocational education, which is organised by one of the regional

education centres, accredited by the Ministry of Education, Welfare and Sports. Each level has its own

conditions regarding the duration and the content of the education. The qualification of these compulsory

educational preparations is recognized nationally.

The institution regulating the education is called Calibris (Landelijke Kwalificaties intermediate vocational

education Verzorgenden IG) being responsible for the accreditation of training companies and the

maintenance of the qualification for the sectors Care, Welfare and Sport.

There is no mandatory registration for level 1 and level 2. But, as individual health carers (level 3) have also

tasks and duties in the range of the working field of registered nurses (technical nursing procedures) , they are

required to register in the BIG register. The BIG register wants to protect patients or care receivers against

incompetent and negligent acts of caregivers.

The skills and competences demanded by the workplace differ in each level. General important skills of all

three levels are to give physical and emotional support to patients. For individual health carers (level 3) also

the nursing procedures like medication, injections, feeding tubes and other technical nursing procedures are

very important skills.

Furthermore, the Dutch nursing system, considers other levels that correspond to the “nurse” figure -

verpleegkundige:

- Level 4: MBO-Verpleegkundige

- Level 5: HBO-Verpleegkundige

- Verpleegkundig Specialist : Master of Advanced Nursing Practice (MANP)

NURSES

Along with doctors, nurses are among the most important professionals in health care. In today's health care

institutions nurses work with the most advanced equipment, they are involved with innovative treatment

plans, they direct care and, as trend watchers, must monitor health risks both for individuals and groups and

take (preventative) action (this is also called public health).

The study of nursing is an education in a profession of health care aimed at caring for people to help them gain

or recover their health and quality of life. Nursing is a healthcare profession ensuring the well-being and health

of patients. Nurses are responsible for the proper implementation of medical prescriptions and giving patients

the care they require. Those trained in nursing are involved in everything from tutoring and supervising new

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nurses and students, acting as a team leader and delegating work. Nurses also keep in contact with patients

and their relatives on a daily basis.

They support and evaluate treatments and therapies in order to ensure an optimal recovery.

Figures from the national statistics office CBS show there were 180,000 registered nurses in the Netherlands at

the end of 2014, a drop of around 33% on the previous year. The decline is due to the introduction of new

rules requiring all nurses to re-register in the Dutch health professionals register BIG: it is not possible to work

as a nurse in the Netherlands without being in the BIG register. Nurses who had not had sufficient patient

contact and training in the previous years were automatically scrapped.

There are several programs for the nursing job. It is possible to follow nursing course at MBO (institutes for

intermediate vocational education) level or HBO (institutes for higher professional education) level. There are

also specific Master's programs for nurses.

The Bachelor of Science in Nursing (BSN) is internationally recognized.

(Permanent Advisory Committee on Nursing Affairs “The Profile of the Nursing Profession” cited by Oud

Nicholas in “The Netherlands” in Quinn and Russell The European Dimension (Scutari Press, 1993), p. 160.)

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LEVEL 1: ZORGHULP – AUXILIARY HELPS OR CARE ASSISTANTS

The auxiliary help works in contact with young people, the elderly, people with disabilities, patients who are just out of the hospital, people with

health problems and the family of the clients.

No training is necessary but a one-year vocational training is available.

In order to be an auxiliary help it is necessary to:

• at least have reached the age of 18 years, • being able to speak and write Dutch. This qualification is still possible for inhabitants of The Netherlands for whom Dutch is not their first

language and who have lower language skills. The duration for trainees with little language skills is 1.5 years, as they are trained in

language courses too.

The figure is able to work in nursing homes, care facilities and in clients' homes.

In the first half year, there is training at school. In the second half year, there is both, school and internship (21 hours a week).

(Home care Across Europe; Contee Project)


KNOWLEDGE know what - theoretical and/or factual knowledge


COMPETENCES know how to be

/

Facility management Providing home care Providing help with daily tasks and activities

Household work; Signalling functions; To help the client in their daily activities (helping clients with daily personal care such as washing, dressing, using the toilet and feeding themselves carrying out general tasks such as housework, laundry and shopping, etc.).

Friendly and caring approach and the ability to relate to people ; Patience and a sense of humour are also important.

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LEVEL 2: HELPENDE - HOME HELPER/HEALTH AND WELFARE ASSISTANT

The training of the health and welfare assistant (level 2) lasts 2 years. The course consists of eight periods of ten weeks. The first two periods (20 weeks total) are

at school. After 10 weeks, they start with an internship of one day per week that introduces them to the practice. After the 3rd period, the internship time is 2

days a week.





/

To provide care and support based on a work plan; Support the independent functioning; Perform organization and profession-related tasks.

To create a work plan based on the care-, living-, activity plan; To give household support for the living area maintenance; give support with personal care/activities of daily life; support social activities; how to act in unexpected situations; support of client/care recipient in emotional area; support of client/care recipient in coping.


LEVEL 3: VERZORGENDE - INDIVIDUAL HEALTH CARER

The Training for individual health carer (level 3) lasts 3 years. Two ways to accomplish the education are possible. Either one decides to study full time (40 hours a

week) with internships breaks or one does his degree with a 24 hour working contract (minimum) at an acknowledged apprenticeship institution and additional

education days.

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/

To provide care and support based on the care plan; Supervise the care recipient, based on the care plan; Perform organization and profession-related tasks

To make a care plan; support in basic personal care; provide palliative care; support for household and living; perform of nursing procedures; monitor of health in both somatic and psychosocial areas; provide information, advice and instruction; able to act in unforeseen crisis situations; accompany the care recipient in coping strategies ;accompany the care recipient in psycho-social areas; accompany the care recipient in the social field; supervise a group of care recipients in the social field; provide guidance in a specific industry (e.g. elderly homes, people with intellectual handicaps etc); work on professional development and professionalization of the profession; work on the promotion and monitoring of quality; tune of the different care actions; evaluate the care.


LEVEL 4: MBO-VERPLEEGKUNDIGE

The MBO Nurses work with people who need specialist help or care due to illness, old age or disability. The accompaniment varies by patient. They can face with

situations where the (mental) health of the care recipient changes rapidly. This relates to situations where intensive treatment, therapy or medication is applied.

They work independently and are partly responsible for drawing up care plans.

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The MBO-4 nursing training can be in two ways: through the Apprenticeship Training (BBL, working and learning) and through vocational training (BOL, learning

and internships). In both cases the training takes four years.

Exemptions:

In certain cases it is possible to shorten the training (with relief for a number of subjects) to follow. This is the case when they are in possession of a diploma

MDGO VZ (long) and MDGO VP or if they already have (volunteers) experience. It is possible to evaluate they experience through an EVC procedure (Recognition

of Prior Learning). You can sign up for an EVC procedure at an ROC. Following an EVC procedure are costs attached.





/

To draw up care plans; To supervise an apprentice or trainee.

To discuss and report of changes in

the nursing situation;

provide information on care

recipients;

To give medication and perform

nursing skills;

nurse care and counselling;

support and guide rehabilitation,

chronically ill or demented caretaker

co-ordination of the total nursing

process;

LEVEL 5: HBO-VERPLEEGKUNDIGE

The level 5 nurses learn how to deal with patients with disabilities (threatening) illness or disability. They get theory of ethics, physiology and anatomy of the body.

In addition, they learn the organization of care.

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Many graduate nurses usually work in nursing home, hospital, psychiatric institution, etc.

The HBO bachelor nursing can be followed via different pathways: full-time, part-time or via the dual variant.

They work on the recovery of patients in the ward care, hospital or psychiatry. They play a pivotal role and coordinate the contact among patients, carers and

other professionals. They can work in all sectors of health care.

They learn which nursing care the patient needs and how to give this care (in more complex situations) and how then implement a nursing plan. The nursing care

is patient oriented and is determined in consultation with the patient and his family. You also work on care programmes, nursing policy, quality care, care renewal

and expertise stimulation.





/

To focus on the patient with his demand and needs

To work on care programmes, nursing policy, quality care, care renewal and expertise stimulation

Patient oriented and determined in consultation with the patient and his family

(Avans-hogeschool, Hanze University of Applied Science)

VERPLEEGKUNDIG SPECIALIST: MASTER OF ADVANCED NURSING PRACTICE (MANP)

A nurse practitioner is a Master of Science educated nurse (NLQF/EQF level 7) who has completed the Master Advanced Nursing Practice, which is accredited by

the NVAO (The Accreditation Organisation of the Netherlands and Flanders). He/she has previous experience in nursing on a Bachelor of Nursing level, and is

employed to treat a defined group of patients with whom he/she will engage in an individual treatment relationship. From the patient’s perspective, care and cure

are offered jointly to promote the continuity and quality of both nursing care and medical treatment. The patient’s ability to self-manage and safeguarding his/her

quality of life play a central role.

The title ‘Nurse Practitioner’ is protected by law and exclusively reserved for those who have completed a Master Advanced Nursing Practice and are registered in

the specialist register.

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The nurse practitioner is registered in the specialists register (article 14) of the BIG Act (the Netherlands Individual Healthcare Professions Act). With the coming

into force of the experimental article 36a and the corresponding government decree of 1 January 2012, the nurse practitioner can lawfully enter into an

independent treatment relationship with a patient.

A nurse practitioner as defined in article 14 of the BIG Act distinguishes him/herself from a regular nurse as defined in article 3 of the BIG Act.

The nurse practitioner fulfils the role of a clinical expert.

(Verpleegkundigen & Verzorgenden Nederland)





NURSE PRACTITIONER

To work in somatic or mental healthcare and have competences in both the nursing and medical area. To provide care on an expert level and medical care in accordance with protocols in his/her area of expertise

To provide patient-oriented care on an expert level; To take care of effective communication and interaction with patients and other parties involved; To collaborate with other professionals on the basis of equality with the objective of realising optimal patient care; To participate in the decision-making involved in organising care in the different fields of the healthcare system; To promote the health and the well-being of patients and population groups; To contribute to the development and implementation of clinical and scientific knowledge and the spreading of nurse practitioner expertise; all this to ensure an ongoing learning process;

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To contribute to the development and implementation of clinical and scientific knowledge and the spreading of nurse practitioner expertise; all this to ensure an ongoing learning process; To practice the profession in an expert, qualitatively good manner, resulting in an accurate assessment of the individual situation of a client, professional intervention, a specific treatment plan and always acting in a procedurally correct way.

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29 OLDER PERSONS HOMECARE IN POLAND

29.1 Introduction to older persons homecare service in Poland

Poland is the largest country in central and Eastern Europe and covers an area of 312,685 square kilometers77.

In 2015, the Polish population amounted to 38,612,000 and the life expectancy at birth, after years of decline,

has reached for both sexes 77.5 years (of which 81.3 years for women and 73.6 years for men) and the healthy

life expectancy at birth has reached 68.7 years78. The total expenditure on health as % of GDP reached the 6.7

in 201379. Elderly people remain at lower risk of poverty.

In Poland, the families are the main source of care for the elderly80.

As other European Union Member States, basing on the European Year for Active Ageing and Solidarity

between Generations, or EY2012, Poland has worked on a new conception of the senior policy and

implemented the National Programme of Social Activity for the Elderly for 2012-2013 (Rządowy Program na

rzecz Aktywności Społecznej Osób Starszych na lata 2012 - 2013) and has created the Advisory Council for

Seniority Policy (Rada ds. Polityki Senioralnej)81. Thanks to this experience, the Council of Ministers has

adopted the so-called “Package for Seniors” on December 24th, 2014, that is the Long-term Senior Policy in

Poland for years 2014-202082.

In fact, the main causes of the changes of the European society demographic structure are the low fertility

rates and lengthening of life expectancy. As a result, the proportion of older people (60 +) is growing

everywhere and also in Poland83.

Moreover, Eurostat data show that people over 60 years will represent nearly 25% of the population of Polish

society in 2020. These data are confirmed for Poland by the Central Statistical Office (forecast for 2008 –

2035)84.

77


http://apps.who.int/gho/data/node.main.688?lang=en 79

http://www.who.int/countries/pol/en/ 80

Home Care across Europe, Case studies, Edited by Nadine Genet, Wienke Boerma, Madelon Kroneman, Allen Hutchinson, Richard B Saltman, European Observatory on Health Systems and Policies, World Health Organization, 2013, 215. 81

Long-term senior policy in Poland for the years 2014-2020 in outline, page 53. 82



Long-term senior policy in Poland for the years 2014-2020 in outline, page 7.

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As a result, Poland has defined its “Senior policy” that includes a package of actions performed by public

administration at all levels and other organizations and institutions that perform tasks and initiatives shaping

the conditions of a dignified and healthy aging85.

In the last decades, Poland is transforming its health care system from a centralized architecture to a

decentralized organization86. Home care is situated within the health care and social assistance systems. The

Ministry of Health is responsible for health policies and regulations and the Ministry of Labour and Social

Policy is responsible for social policy and its implementation. The National Health Fund, Narodowy Fundusz

Zdrowia - NFZ, is responsible for signing contracts for the delivery of specific health care quality services (Law

on Health Care Services Financed from Public Sources 2004). Moreover, health services financed from NFZ are

generally free of charge for insured persons. Services from social assistance are financed by local authorities

and are frequently co-paid for by the users. The typical home care services are mainly the primary care

delivered by family physician and family nurse; the new home care services are the long-term home nursing

care, the home hospice, the home care for people with complex needs and medical rehabilitation at home.

They are financed from health insurance. According to the Law on Universal Health Insurance with the

National Health Fund 2003, co-payments apply to the costs of medicine, dressings and other specialised

supplies. Taxation is the main source of funding of social assistance services (basic personal care, house

cleaning, shopping and supply of meals) that are financed by the local governments (community “gmina” and

district “powiat”), the central budget and by the client’s co-payments proportionate to their income. On the

community (gmina) level assistance is provided in the place of residence of the beneficiary and day care homes

(half-institutional assistance). Assistance may include financial help (permanent, temporary and intentional

benefits) and services (home aid and some personal care). At the district level some specialized services (e.g.

counselling, rehabilitation) and social care homes are organized. An additional source of financing is the

National Disabled Persons Rehabilitation Fund (PFRON). The Law on Social Care (2004) describes the role of

governmental administration and local governments87.

85


Health systems in transition, Vol. 13 No. 8 2011, Poland Health System Review 2011, European Observatory on Health Systems and Policies, World Health Organization, 2011, page 47. 87

Home Care across Europe, Case studies, Edited by Nadine Genet, Wienke Boerma, Madelon Kroneman, Allen Hutchinson, Richard B Saltman, European Observatory on Health Systems and Policies, World Health Organization, 2013, page 215, 217-218.

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Social sector services are paid per hour of care and may be carried out by local authorities or be delegated to

profit and non-profit organisations (Polish Red Cross, Caritas, Polish Social Care Committee)88.

Nowadays, according to the Law on Health Care Services Financed from Public Sources 2004, the NFZ manages

the obligatory health insurance premium contribution which pays the health services that are generally free of

charge for insured people. In this framework, long-term healthcare can be delivered at patients’ homes unless

they choose to stay at long-term care residential institutions, usually not classified as hospitals, which are co-

financed by the clients. The social assistance mainly consists of cash benefits and non-financial support such as

services in the form of social work, care services and specialist counseling. It is organised by units of central

and local administration in cooperation with other organisations (foundations, associations, churches, religious

groups and employers): municipalities and communes - social assistance centres; districts (poviats) - poviat

centres for family support, in regional social policy centres - voivodships89.

In Poland, traditionally, the family takes care for elderly and/or disabled people. Nevertheless, changes in the

families and in values have been observed as well as the decline of the member in feeling responsibility for

care. The home care for the elderly is included in the framework of the long term care services. At the

present, the organisation of long-term care services in Poland is well represented by the following figure both

for public and private services90.

Figure 26: Framework of the long term care services

88



The Present and Future of Long-term Care in Ageing Poland Policy Note, The World Bank, 2015-11-30, page 22.

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Institutions that provide health and social services usually work separately and, as a result, there is insufficient

cooperation between the health and social care sectors mainly due to their separation. In most cases,

healthcare professionals (i.e. family nurse, family doctor or long-term home care nurse) and an informal carers

play the role of coordinator91.

As shown in the figure above, public long term care services92 for dependent elderly are provided by:

• the health sector, including a range of medical services; and

• the social sector, including care for dependent elderly people in a socially difficult situation (living

alone, come from dysfunctional families, or poor).

These sectors deliver both home care and 24/7 residential care services. In addition, cash transfers are

available to different types of beneficiaries, such as older people and dependent people with motor

disabilities. In particular, home care93 comprises nursing services, delivered by means of the health sector and

managed by the primary health care units after the assessment of health needs, and care services delivered by

the social sector and managed by the social assistance centers that previously assess the income and the

family difficult conditions. Finally, special cares are targeted at people with mental health problems.

The home care services of the NFZ delivered at the patient’s home concern the care provided respectively by

the primary care nurse and by the long- term home care nurse. All insured patients are eligible for primary

care nurse service and can choose their primary care nurse. The nurse plans and delivers complete nursing

care in a primary care practice, identifies and assesses the patients’ health needs and, finally, executes short-

term doctor’s orders. Moreover, the nurse has the following tasks: health promotion, nursing care and

collaboration with other agencies94.

The long- term home care nurse services are those services directed towards the needs of any chronically ill

and handicapped patients staying at home. In these cases the eligibility is based on Barthel index and is

monthly reassessed. For this service some limitations exist as the demands exceed the supply of services

contracted by NFZ95.

The domestic aid service (but also basic personal care) depends on the system of social assistance: it consists

of services at home bases on a persons’ needs and the personal situation. It may include: basic personal care,

house cleaning, shopping, being brought to a doctor, etc. In this case, the client may financially participate

91


The Present and Future of Long-term Care in Ageing Poland Policy Note, The World Bank, 2015-11-30, page 22. 93




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according to his/her income. These services are mainly delivered to persons without family support, or when

family care is ineffective96.

The health and the social sectors also provide public residential services97 with different eligibility criteria,

financing rules and types of services. The health sector offers care and treatment facilities (zakład opiekuńczo-

leczniczy ZOL), nursing and care facilities (zakład pielęgnacyjno-opiekuńczy ZPO) and palliative care homes; the

social sector offers two kinds of residential homes: stationary (social assistance homes – DPS) and family

nursing homes that can accommodate full-time residents including those persons who require permanent

institutional care. Different types of family nursing homes exist in Poland. Family nursing homes provide care

and residential services 24/7 from three to eight people and are targeted at the elderly or the disabled persons

who require a permanent assistance.

Semi-residential care services98 are provided by the local governments. In particular, the social assistance

centers manage day nursing homes dedicated to old people living with their family but whose members

cannot provide them care due to their professional activities. The services are generally provided between

09.00 am and 04.00 pm, 5 days a week. Day nursing homes provide a range of activities such as excursions,

exhibitions, etc.

Cash benefits99 are provided by public institutions to specific types of and needs for care and include old

people. In particular, the benefits concerning the elderly are:

• Nursing benefit (zasiłek pielęgnacyjny) is a care-related benefit granted to different people included

the over 75 years of age;

• Care supplement (dodatek pielęgnacyjny), a universal benefit granted to persons entitled to an old-

age, disability or survivors’ pension who are over 75 years old as well as to persons of any age who are

entitled to an old-age, invalidity or survivors’ pension, and are completely incapable of working and

need every-day assistance.

Orthopaedic equipment and assisting means prescribed by a doctor of a particular specialization, are subject

to a refund from the NFZ (up to a certain price). If the patient is not able to pay the costs over the price limit or

if the equipment is not refunded by the NFZ, the district level social assistance center may grant money from

the National Disabled Persons Rehabilitation Fund (PFRON) budget100.

96

Home Care across Europe, Case studies, Edited by Nadine Genet, Wienke Boerma, Madelon Kroneman, Allen Hutchinson, Richard B Saltman, European Observatory on Health Systems and Policies, World Health Organization, 2013, pages 215-216. 97

The Present and Future of Long-term Care in Ageing Poland Policy Note, The World Bank, 2015-11-30, pages 22-23. 98

The Present and Future of Long-term Care in Ageing Poland Policy Note, The World Bank, 2015-11-30, pages 24-25. 99



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The following table represents the services and benefits related to long-term care101.

Health sector Social

assistance/Family benefits

Social security

Residential care Care facilities (ZOL, ZPO), hospices, and palliative care units

Social assistance homes (DPS)

-

Day care - Day care centers -

Social services Assisted living facilities Home services and specialized home services

-

Cash benefits -

Nursing benefit (zasiłek pielęgnacyjny) to caregivers of disabled children and people 75+ (153 PLN/month)

Care supplement (dodatek pielęgnacyjny)-universal benefit to 75+ (206.76 PLN/month)

Table 36: the services and benefits related to long-term care

In Poland a remote tele-care service is not financed by the public sectors and, to use it, it is necessary to pay by

own resources102.

Home care personnel

In Poland, to practise defined health professions, it is necessary to be member of the specific chamber.

Professional chambers Physicians, dentists, pharmacists, nurses and midwives, and laboratory diagnosticians

are associated in professional chambers that represent their interests. In particular, the chambers implement

different activities, provide expert opinion or arbitrates on professional responsibility matters, participate in

the establishment of the education standards, maintain the registers of licensed and active professionals,

develop ethical codes of practice and may impose disciplinary measures on their members, etc103. The

profession of nurse is defined by the Law on Nurse and Midwife Profession (1996) and by the Decree of the

Minister of Health regarding the type and range of preventive, diagnostics, therapeutic and rehabilitative

services provided by nurse or midwife independently without doctor’s order (2007) which also describes the

area of competence of the nurse (such as dressing of burns and wounds, treatment of bedsores, condition of

additional training104). To practise as a nurse, generally, it is necessary to have a nursing bachelor’s or master’s

degree, according to the Decree of the Minister of Health regarding the guaranteed services in the field of

nursing and caring services in long-term care (2009); long-term home care nurses should be qualified having a

101



Health systems in transition, Vol. 13 No. 8 2011, Poland Health System Review 2011, European Observatory on Health Systems and Policies, World Health Organization, 2011, page 23. 104


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qualification course and/or specialization in fields such as long-term care, family care, chronically ill and

disabled people’s care or internal or geriatric nursing105. Finally, if a nurse remains out of the job for five years

it is required to undergo training and pass recertification exams106.

To be a social worker, it is required to meet one of the following conditions:

1. To have a diploma from the College of Social Service Workers,

2. To be graduated from university in the area of social work,

3. To be graduated from university with a specialization preparing for the profession of social worker

(Law on Social Care 2004).

The professional qualifications on providing formal care services are changing and in recent years it aims to

replace unskilled workers in the field of home care. As a result, the education system is changing too107.

29.2 HHCP involved in older persons homecare service in Poland: roles and

competences

As already mentioned, in Poland, public care for dependent elderly people is provided through two sectors:

• the health care sector that includes cases of dependency care, requiring a range of medical services;

• the social sector that includes care for dependent elderly people who are also in a socially difficult

situation (i.e. living alone, come from dysfunctional families, or are poor).

Following this logic, also home care is provided in the two sector.

Traditional home care within the healthcare system is provided almost exclusively by primary care (family

physician and family nurse). In the framework of the long-term care, at present, new forms of home care

services have been created, such as: home nursing care, home hospice, home care for people with complex

needs and medical rehabilitation at home.

The main figures involved in the LTC home care in Poland are:

� for the health care sector: nurses

� for the social assistance sector: social workers

Within the social assistance system, domestic aid and basic personal care at home is provided by the “home

care assistants”, which offers basic personal care, house cleaning, shopping, transport, etc. Financial

participation of the client depends on the income and only if it is below social assistance criteria, the client

gets the right to free services.

105




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Nevertheless, recent studies show that care for the elderly disabled people in their home environment is

mainly based on informal networks of family carers108.

NURSES

Forms of nursing health services contracted by the NFZ and delivered at the patient’s home and include care

provided by:

1. PRIMARY CARE NURSE

2. LONG-TERM HOME CARE NURSE

The profession of nurse is defined in law by the Law on Nurse and Midwife Profession 1996 and by the Decree

of the Minister of Health. According to the law, nurses have the right to professional independence and can

sign separate contracts with clients.

PRIMARY CARE NURSE

The primary care nurse plans and delivers comprehensive nursing care in a primary care practice and at a

patient’s home.

In order to practice as a nurse, it is necessary to have a nursing bachelor’s or master’s degree.

LONG-TERM HOME CARE NURSES

In 2004, the NFZ has introduced a new form of nursing care: the long-term home care nurse. This type of nurse

is addressed towards the needs of any chronically ill and disabled patients staying at home.

Long-term home care nurses should have a qualification course and/or a specialization in fields such as long-

term care, family care, chronically ill and disabled people’s care or internal or geriatric nursing (Decree of the

Ministry of Health regarding the guaranteed services in the field of nursing and caring services in lont-term

care 2009).

The long-term home care nurse needs a referral from the doctor.

108

Home Care across Europe, Case studies, Edited by Nadine Genet, Wienke Boerma, Madelon Kroneman, Allen Hutchinson, Richard B Saltman, European Observatory on Health Systems and Policies, World Health Organization, page 221.

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NURSES

OCCUPATION ROLE

(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS

know how to do - SKILLS as cognitive (involving the use of logical, intuitive and creative thinking) and practical (involving manual dexterity and the use of methods, materials, tools and instruments)

COMPETENCIES

know how to be - competence in terms of responsibility and

autonomy, being able to evaluate,

making judgements, managing a complex

task in a context taking decisions, etc.

NURSE PRIMARY CARE

NURSE

To do a variety of everyday basic nursing procedures. To plan and deliver comprehensive nursing care in a primary care practice and at a patient’s home.

To identify and assess the patients’ health needs, health promotion, nursing care and collaborate with other agencies. To perform a self-evaluation of the services provided, making a nursing diagnosis and a care plan. To diagnose patients’ condition and their health-related needs; To identify patients’ needs related to nursing; To plan and provide nursing care of patients; To independently provide any preventive, diagnostic, treatment, rehabilitation as well as medical emergency services, in the specified scope; To perform medical orders in the diagnostic, treatment and rehabilitation process; To decide on the kind and scope of nursing services; To teach how to exercise the profession of a nurse and take certain measures aimed at the professional training of nurses; To conduct scientific and research work in the field of nursing; To lead and manage nurses’ teams; To be employed in healthcare facilities in administrative positions, which shall entail performing activities related to arranging for, organising or supervising the provision of

To perform their profession with due diligence, in accordance with the principles of medical ethics, by respecting patients’ rights and taking care of their safety, and to the best of their current medical knowledge.

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healthcare services.

LONG-TERM HOME CARE NURSE

To be specialized in long-term care, family care, chronically ill and disabled people’s care or internal or geriatric nursing.

To provide physical and psychosocial support to patients and their families.

29.2.1 References

Ministry of Health Republic of Poland

http://www.mz.gov.pl/en/healthcare-system/health-personnel-and-training/nurses-and-midwives/

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30 OLDER PERSONS HOMECARE IN PORTUGAL

30.1 Introduction to older persons homecare service in Portugal

The territory of Portugal includes an area in the Iberian Peninsula (called the continent by most Portuguese)

and two archipelagos in the Atlantic Ocean

The population is nowadays 10.339.000 people, with a population density of 125 inhabitants/ km. In 2014 the

population over 65 years amounted to 20.01% and the aging index (number of elderly / 100 youth) was 138.6.

Life expectancy (in 2013) at age 65 was 17.2 years for males and 20.6 years for females. The healthy life

expectancy or disability-free life expectancy, at age 65 (in 2014) was 6.9 years for males and 5.6 years for

females

The provision of health care and social support at home aims to the maintenance of users in their family and

social environment. It takes place on two levels

I. Through the "network of national care continued integrated"

II. By social benefit of home support systems

National network of integrated continuing care "(RNCCI). "

The RNCCI is made up of entities public and private (Private institutions of Social solidarity (IPSS) and Holy

House of mercy) that provide continued care health and social support when necessary, to persons in a situation of dependence, at home or in other institutions. They used four types of resources: 1 - inpatient units. 2 units for outpatients. 3. hospital equipment of

continued health care and social support. 4 equipment home of care continued health and social support.

30.1.1 Home of care continued health and support teams

Extension and capacity : The RNCCI is distributed all over the country with the set of all resources is able to

offer attention, in data of February 2016, to 6.289 users: 1673 - North; 846 - Center; 2136 - Lisboa e Vale do

Tejo; 549-Alentejo e 1085 Algarve. Access to the seats is subject to existing availability.

Regulatory authority : Ministry of labor and Social solidarity (MTSS), and ministries of health. (MS)

Financing : Co-financing. A part of the MTSS, National Health Service (belonging to MS), private institutions of

solidarity Social (IPSS), Santa Casa de Misericordia , or the users own. On the other hand the user, who only

pays the costs of social support, total or partial form depending on the economic situation of personal and

family.

Dependence and coordination:

• level National: MTSS

• level Regional: regional administrations of health of each of the five existing areas: North, Central, Lisboa

and Vale do Tejo, the Alentejo and the Algarve; Through giving them regional coordination teams

• Local: teams, in principle of municipal level. The teams local coordinators are composed of at least one

doctor, a nurse, a social worker and, whenever necessary, a representative of the local authority

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Profile of beneficiaries : ∙ functional dependence (unless motor) temporary or prolonged complex ∙ elderly

fragility ∙ severe disability criteria, with a strong psychological impact or social ∙ disease severe in advanced

or terminal phase.

* Pre-requisite prior availability of some social support and not need hospitalization

Gateway to the service : ∙ users in hospital: through the management team of high ∙ users in the community:

from the center of health through the doctor or social worker.

SOCIAL BENEFITS SUPPORT HOME

Social benefits support home Is a system of social support that offers seven types of resource: ∙ Centre of coexistence; ∙ Centre day ∙ middle of night ∙ residential structure for elders∙ family shelters for older persons and adults with disabilities ∙ homecare service.

30.1.2 Home care service

Focusing on the "family helpers" who are workers who provide care basic social support, persons in situations

of dependency, in their home.

Gateway to the service:

• Directly in the institution or establishment of social support that provides support;

• Santa Casa da Misericórdia of Lisbon.

• Care of the residence Social security services.

This type of service availability can also be found in the list of social resources on the web site of "the

Social Charter".

Profile of beneficiaries : People who are in their homes in situations of physical or psychological dependence

and cannot ensure, temporarily or permanently, the satisfaction of their needs of daily life, or have family

support for the purpose.

Financing ( : 1) Co-pay of the user (only in the aforementioned institutions) according to family income. 2nd)

subsidy from Social Security.

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30.2 HHCP involved in older persons homecare service in Portugal: roles and competences

OCCUPATION / HHCP

ROLE KNOWLIDGE SKILLS: COMPETENCIES

Nurse of general care

-Preventive, -Healing, of -Rehabilitation or -Hospice

-Use assessment tools to identify actual and potential risks. -Administration of medication.

- Provides support / education in the development and maintenance of the capacity for independent living. -Ensures that the individual and / or caregivers to receive and understand information about care to that will be provided. -Establishes priorities for care, when possible, in collaboration with individuals and / or caregivers. -Implement infection control procedures.

-Formulates a plan of care, wherever possible, in collaboration with individuals and / or caregivers. -Review and reformulate the plan of care on a regular basis, whenever it is possible, in collaboration with individuals and / or caregivers. -Ensures the safety of the administration of therapeutic substances. -Participates with members of the health team in making decisions regarding individual ao. -Review and assess loscuidados with members of the health team. -Consulted experts in nursing, when nursing require a level of expertise that is beyond their current competition or out of the limits of his exercise area. -Consultation with other professionals and organizations sanitary needs of individuals or groups over their exercise area.

Nurse specialist in Rehabilitation nursing

-Physiotherapy (+) -Preventive, -Healing, of -Rehabilitation or -Hospice

Not specified

-Identify architectural barriers and prepares proposals for their elimination. -Provides rehabilitation care. -Creates and administers grants for technical support,

-Creates, implements, and controls the rehabilitation plans based on health problems real and potential resulting from a change in the functional capacity of the elderly and/or alteration of the way of life that results from disability / disability or chronic illness. -Take decisions related to the prevention of secondary complications/disabilities, health

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promotion, treatment and rehabilitation, maximizing the potential of the person. -It promotes maximum independence in ADL and the quality of life

Nurse specialist in nursing in Psychiatry and mental health

-Mental health-related aspects (+) -Preventive, -Healing, of -Rehabilitation or -Hospice

Not specified

-Health promotion through information and education strategies. -Promote coping mechanisms to deal with situations of suffering, minimizing the impact of mental illness in individuals, families and groups. -Provision of care people elderly, families and groups with mental health problems, enabling through therapeutic and psychotherapeutic interventions to facilitate their adaptation,

-Promotion of mental health in the elderly, families and groups, enabling them to adopt healthy behaviors for positive and active aging; -Prevention of mental disorders, allowing people to develop protective factors, reduce risk factors, with emphasis on reducing co-morbidity of mental illness in people with chronic disease or long-term evolution. -promote the recovery, rehabilitation and psychosocial rehabilitation - includes care for people with chronic diseases or prolonged evolution, promoting processes of adaptation to disease, death or mourning processes follow.

Nurse specialist in nursing of community health

-Training And information about prevenciaon (+) -Healing, of -Rehabilitation or -Hospice

Not specified

- Assisting individuals, families and groups more vulnerable and subject to exclusion factors.

-Create, implement, and evaluate educational strategies to train the person and the community in the pursuit of health and citizenship projects, helping people and families to experience the processes of transition and not normative events and help vulnerable and risk groups such as older persons dependent on the achievement of the health benefits and improve the quality of life. -Establish network of causality of the problems with the determination of the causes and factors of risk and, therefore, stimulate and lead programs for intervention in the field of prevention, protection and promotion of health. and health -Cooperate with the health and social services

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network. assisting individuals, families and groups more vulnerable and subject to exclusion factors.

Nurse specialist in nursing of health of the elderly and Geriatrics

-Aspects of the geriatric patient care -Preventive, -Healing, of -Rehabilitation or -Hospice

Not specified

Not specified

OCCUPATION / HHCP

ROLE KNOWLIDGE SKILLS: COMPETENCIES

FAMILY

ASSISTANTS

Help home -Food hygiene

- Preparation and drug and food administration

-Help in the task of food, clothing, hygiene and comfort.

-Basic knowledge of Gerontology and disability

-Give users the prescribed medication

-Basic knowledge

of Gerontology and

disability

-Mobilization techniques -Adapt to the changes that will check on the overall situation of the users.

-Hygiene of the bedridden

-Basic knowledge

of Gerontology and

disability

-Human relations

-Act in order to overcome situations of isolation and loneliness;

-Family economics

-Collaborate with families, ensuring adequate

information on the relevant aspects to ensure the

health and well-being of families

-Carry out services abroad and accompany

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31 OLDER PERSONS HOMECARE IN ROMANIA

31.1 Introduction to older persons homecare service in Romania

General information about the country

Extension 238.391 km2 (9th largest EU country)

Population: 21 million people, (7th largest country in the EU). 16.5% of the population is older than 65. The

forecast for the year 2050 is that this rate will reach 30%.

Population in a situation of dependency At the end of 2015, the dependent population was 766 153 people.

The 40, 89% of the dependent population has more than 65 years being predominantly women.

The 2.3% are institutionalized in public nursing homes. 97.7% remaining are at home being cared by caregivers

or family.

Health coverage:

Health expenditure is higher than the EU average. The Ratio of nurses and doctors is less than EU average.

There is a big difference between urban and rural areas, due to the accessibility problems, financial situation

and geographical environment, as well as by the limited existing health transport network. The quality of care

will depend on the social situation because there is only a basic coverage.

Health care at home is given by the home care team, which is composed by a social worker, doctors,

psychologist and nurse. Related with their performance and needs valuation, the social coverage can be

derived.

Other professionals involved in home health coverage are the nursing assistants, which intervene medically.

Physical therapist, involved very occasionally, also after medical indication and finally almost testimonial form

the speech therapist.

Occupational therapists are basically responsible for the transition from hospital to home and proposes the

adaptation of the House, but don´t perform any other activity directly with elders.

Social protection:

Public social attention focuses mostly on orphanages and psychiatric institutions. Elderly care in institutions is

low, it has a social-health character and it is carried out

• elderly care Hospital (equivalent to nursing homes in other countries), which is accessed by a doctor report.

• Nursing homes of the State, less health care and more social.

• Private nursing homes with or without profit.

Elderly´s needs attention at home

It shows a very irregular distribution across the country. The legislative instability for years has directly

affected this coverage.

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There is a framework regulation that defines, under cover of law 17/2000, who are the elderly beneficiaries of

the home care. These would be the following: people without family or caregiver assigned. People who have

no home ownership or sufficient financial resources. People whose income is not enough to be able to take

care of yourself alone. People with health problems who need specialized help. People with physical or mental

problems who do not can take care of themselves.

Also under the protection of the law 292/2011 are defined standards of services, which are classified in: •

services basic social assistance (of documentation management) • support services, • monitoring of medical

treatment. Assistance in transport

Regulatory authority: Ministry of labor, Social Security and family.

Main document: order of the Ministry of labor 2126 / 2014, annex 8, laying down minimum quality standards

for home care for the elderly services

Financing and access:

Home care services are financed through public funds, (with very small amounts allocated to Central or local

budgets). It does not allow part-time or hourly payment for services. The same co-pay formulas are used.

When service providers are direct relatives, there are formulas for compensation in the form of the labor and

social benefits of face to the retirement of the caregiver. There is also a private coverage, usually through

NGOs

The indication by doctor or medical specialist hospital after suffering an illness that has needed hospitalization

is required for access to home care.

31.2 HHCP involved in older persons homecare service in Romania: roles

and competences

The coverage is carried out through two networks:

Informal network: formed by family, neighbors and friends; It supports more than 90% of the attention. The

relatives are a group of support which is essential.

Network of authorized caregivers by the Government: with or without training.

• Caregiver without certifying: the vast majority

• Personal assistants: generally follow the training given by the local authority which authorizes them, but no

particular requirements.

• Certified for elderly caregivers: often complete a training program for six months (620 hours) in care for the

elderly, and receive a certificate;

• Caregivers certificates for ill persons they attend

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Training of careers It is delivered from the public sphere or from the private sphere, in this case mostly by NGOs. The training courses have a variable length, from

a few hours. The courses that have accreditation recognized are given from a length of 360 h contents theoretical and practical. Level of primary education (8

years) is required. Training courses, are developed in modules or topics, sometimes they have defined certain powers, but not defined explicitly and generally

specific knowledge, skills, roles, etc., even if they come partially developed programs.

Nursing: own nurses can act in this sector health and social mix. There is a lack of information regarding the work of the nursing home. There is the possibility of

working on their own as a nurse at home but requires authorization.

NURSE

KNOWLEDGE SKILLS COMPETENCIES

1. the process of care - definition, stages, care plan

-Basic needs

-Techniques for patient care

2. the administration of drugs.

3. the biological and pathological processes

4.emergency medical or surgical -cardiopulmonary

resuscitation

-Polytrauma - fractures, sprains, dislocations, hemorrhage

and Haemostasis

-The transport of the patient polytrauma

in respiratory disorders, cardiovascular systems, obstetrics

and Gynecology at the Pediatric

(b) To administer the treatment as

prescribed by the doctor.

(d) To develop programs and

health education activities;

(e)To facilitate actions to protect

the health of groups considered to

be at risk.

To educate

(a) the establishment of the needs of care of the overall

health and the provision of services in general health care,

prevention, cure and rehabilitation.

(c)The protection and improvement of health.

(f) To research in the field of the health care in general

nurse responsible for general licensees.

(g) The participation in the protection of the environment.

(h) The preparation of reports written on the specific

activity carried out.

(i) Organization and the delivery of community health care

services.

(j) The training of nurses theoretical and practice in general

education programs.

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5. the care of patients with respiratory diseases -

6. the care of the patients with cardiovascular disease

7. the care of the patients with kidney disease

8. the care of patients with gastrointestinal diseases

9. the care of patients with neurological diseases -

education

10. the care of patients with psychiatric disorders

11. the care in pediatric patients

12. the care of patients in obstetrics and Gynecology.

13. the care of the patients with skin problems - health

education

- The manifestations of independence, dependence

(Signs and symptoms)

-Diagnostic care

-Objectives and interventions

-Appraisal techniques

-Health plan

14. the care of patients with infectious and contagious

(k) the auxiliary medical staff training;

(l) To carry out educational activities in the schools to

prepare

Future nurses.

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diseases -health education

15. the care of patients in ICU

16. the care of the patients with surgery

OLDER ADULTS CAREGIVER

KNOWLEDGE SKILLS COMPETENCIES

-Verbal and non-verbal techniques...

-General rules of labor protection

-Mobilization techniques

-Assess the behavior of the assisted person

-Evaluation of appetite

- To receive and transmit information

-To respect the general norms of labor protection

-To administer drugs, help practitioners to perform cures.

- To fill the care sheet

- To carry out mobilization and transport

-To check the vital signs: (blood pressure, FC,

Temperature, f. respiratory)

- To make hygiene care

-Help nutrition and manage food

-Apply first aid to the assisted person

-Communication

-Professional development

-The planning of daily activities

-Management of resources allocated

-Compliance with requirements medical:

-Monitor the health of the assisted person

-Ensure the comfort of the elderly

-Ensure hygienic conditions,

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32 OLDER PERSONS HOMECARE IN SLOVAKIA

32.1 Overview on the older persons homecare service in Slovakia

In 2013, 13.96% of the population of Slovakia was older than 65 years, which is less than the EU27 average of

18.02% and ranks among the lowest values. The old-age support ratio, i.e. the ratio between people of

working age (20–64) and people after retirement age (over 65), in 2013 was the highest value among the EU

member countries [Szudi et al, 2016].The population over 65 at risk of poverty is extremely low, with 8%

compared to 19.6%on average in the rest of the European countries [Genet et al., 2013].

The Slovak system relies heavily on institutional care and informal care provision. The most important part of

homecare is the informal care, most often given by family members or close contacts of the care recipient

[Szüdi et al., 2016]. Informal carers are formally recognized. According to the Act on direct payment of

Compensation of Disability (N447/2008) they can receive an income dependent care allowance. As the basic

amount is around € 200 per month it does not cover full-time involvement [Szudi et al, 2016].

Long-term care lacks integrated home care, community, ambulatory or hospital health and social services.

Both social and health care are subject to different legal frameworks and their competences fall into two

different sectors [Szalay et al., 2011].

The need of complex home care in Slovakia has an increasing trend both for clients/patients and for healthcare

workers. Inquiries show that as many as 90% of citizens prefer to have health and social care provided within

their own home settings.

In Slovakia homecare has generally one of these three objectives [Lezovic et al., 2011]:

- to substitute hospital-based acute care; - to substitute institution-based long-term care; - to prevent the need for institutions and maintain individuals in their own homes and communities.

Home healthcare is a new type of care in Slovakia. It is considered homecare both the care provided indoors

(at home), and the care provided outdoors (in a community). This care represents the primary healthcare in

Sloviakia [Lezovic et al., 2011; Genet et al., 2013].; as a matter of fact home care recipients are almost triple

the number of institutional long-term care recipients, which is considerable compared to the other countries.

In the framework of this system, the medical care and social care services for the elderly are separately

organized .Governance on home care is split between home nursing (which belongs to health care) and formal

home care i.e. personal hygiene and household chores: after a failed legislative attempt to integrate the two

kinds of service, a strict division in terms of financing still exists; medical care services are financed by the

Ministry of Health through the health insurance payments, while, under the auspices of the Ministry of Labor,

Social Affairs and Family, social care services are financed at lower administrative levels (in the case of elderly

people, municipalities) through taxation (about two thirds of the social care expenses) and clients copayments

(about one third of the social care expenses) [Genet et al., 2013].

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Partly due to the division in terms of financing and service provision of medical and social care, the home care

system faces several challenges [Szudi et al, 2016]:

- some eligible people do not receive the indicated care.

- inefficient assessment procedures for applying for public financing.

- insufficient financial resources;

- inequality: access to social services varies greatly by local and regional policy institutions [Genet et al.,

2013];

- unequal funding of public and private providers. Such descrepancies are an obstacle to competition.

An overview of the usual types and length of services in selected facilities is presented in the following Table.

Table 37: Overview of the social and medical services provided in the Slovak Republic [Radvanský & Páleník, 2010].

32.1.1 Home healthcare in Slovakia

Although GPs (or their nurse) are legally obliged to visit patients at home, this only occurs sporadically. Home

nursing (but personal care as well) is primarily provided mainly by a single type of organization, namely ADOS

(agentúry domácejo etrovateskej starostlivosti)- home care and nursing agencies. Thre are about 162 ADOS in

Slovakia [Szudi et al, 2016]. These agencies are part of primary healthcare and they belong to the system of

healthcare services. They provide complex special nursing care for clients/patients, families, communities

within their own habitat. It is a self-contained functional unit allowing the provision of nursing care including

prevention, therapy, rehabilitation, counselling, healthcare, as well as social and educational care [Radvanský

& Páleník, 2010]. The service is free of charge after the insurance companies have assessed the individual level

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of disability and found the client to be eligible ADOSs are part of the primary health care system and do not

generally provide home assistance such as help with shopping, cooking, or cleaning [Szudi et al, 2016].

Access to home nursing care formally requires a physician’s referral. Thereafter, an agency’s nurse will assess

the client’s degree of mobility, draft a treatment plan and assign the intervention nurse. The plan needs

approval from the health insurer. In practice this procedure may not always be followed [Szudi et al, 2016].

32.1.2 Social homecare in Slovakia

Home care services are provided by municipalities and self-governing regions or, on their behalf, by private

providers (either for profit or non-profit, such as charity organisations, Red Cross). However, most roviders are

public, although the revised Act on Social Services is said to have complicated financing of private providers

and thus to make private provision less attractive. At national level the eligibility to personal care and

domestic aid/formal home care has been defined in the ‘Act on Social Services’ (Act N 448/2008) and

legislation on ‘Direct payment of Compensation of Disability’ (N447/2008) [Szudi et al, 2016].

A social worker will assess the social situation, while a physician will examine the patient’s health status.

Medical devices and technical aids are prescribed by GPs and paid by the public health insurance agency.

Other devices and technical aids are paid from state budget via financial allowance for severe disability

compensation. Equipment for distant monitoring is on the market, but not widely used as public funding for it

is missing.

Integration between institutional care and social home care social workers are the formal liaison. They must arrange the smooth transfer of patients from an institution to their home

32.2 HHCP involved in older persons homecare service in Slovakia: roles

and competences A professional qualification to perform activities in various health occupations, which is called the basic

qualification in Slovakia, can be obtained after completing:

• a Bachelor’s or Master’s degree in an accredited university programme

• higher vocational training

• full secondary vocational training

• secondary vocational training.

Professional qualifications to perform specialized professional activities can be obtained through a specialized

course/training. Professional qualifications to perform certified professional activities can be obtained through

certified training. Specialized training, certified training and continuous education of health workers are called

“further education/training” in the Slovak system.

Until 2004, the Slovak Health University was the sole provider of further education. Since 2004, other

institutions, accredited by the Accreditation Committee of the Ministry of Health, including medical faculties,

may offer training and education for health professionals. Life-long continuous medical education is obligatory

for every health professional. Relevant professional chambers perform evaluations of continuous education at

five-year intervals. In case of shortcomings, the professional organization may warn the employer or may

notify the HCSA. It may also investigate a health professional or impose sanctions (for example temporary

withdrawal of their licence). The employers must create conditions for further education of their employees

while professional organizations must participate in educational activities and quality assurance programmes.

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European directives emphasise the importance of lifetime education of healthcare professionals, for the

obvious reason, which is the prevention of potential harming of the patient. They lay down the duty of

member states to provide continuing education of healthcare professionals and leave the fulfilment of this

duty in their responsibility.

This obligation appears in conceptual and strategic materials and legal norms of the Slovak Republic as an

obligation of one of the member states of the European Union. According to the Act No. 578/2004 Coll. on

healthcare providers, lifetime education is healthcare professional’s duty. Continuing education is

characterized as a continuous renewal and maintenance of achieved specialized professional competence for

execution of medical profession in compliance with the relevant fields during the entire time of the execution

of relevant health profession.

The following professionals with obligatory education are working in HOME NURSING [Genet et al, 2013]:

• Nurse: performing injections, infusion, wound care, ulcer treatment, etc.; they got bachelor or masters

education.

• Health care assistant: supervised by a nurse, providing elementary nursing, assisting in diagnostics,

prevention and administration; they attend four years basic vocational training.

NURSES

The educational curriculums for nurses and health care assistants have been regulated nationally (by

Government Regulation 296/2010) and the educational programmes must be accredited by the Ministry.

For citizens of the Slovak Republic that have never before gained a nurse qualification, under the new

legislation to qualify as a nurse requires [Beňušová K. 2004].

• a higher vocational education as a trained general nurse in a relevant secondary health school in the

Slovak Republic or

• a level I. university education in a bachelor study program in nursing (Bc.).

Both these programs have to comply with the EU directive stating that the nursing studies have to take at least

three years when studying full time and include 4600 hours, which are equally split into theoretical and

practical training.

Since the nurse training similarly to the dental practitioner training was considerably different to EU

expectations before the entry of the Slovak Republic into EU on the 1st may 2004, the Slovak Republic had to

gradually dampen the full secondary vocational training in nursing and leave only a higher vocational

education.

Only the higher vocational education in general nursing in secondary health schools was rated by the

evaluation mission of the European commission TAIEX in 2002 as fully compatible with the expectations of EU.

The evaluation mission reproached the nurse training in the full secondary vocational education in Slovak

secondary medical schools for starting the training for such an arduous profession already before the nurses

seventeenth year of age, which it considered unacceptable.

In the Accession Treaty of the Slovak Republic into the European Union nurse training gained or nurse training

started within the territory of Slovak Republic before the entry of the Slovak Republic into EU in

nonconforming program classed as a training, based on which the nurse continues in this medical profession

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and all member states will consider her training equivalent, if she worked in the Slovak Republic in general

nursing for at least three years within the last five years.

Considering this, it follows that nurses, who gained their training according to present regulations, can

continue working in the Slovak Republic in specialized nursing work in present scope without having to

supplement their education with a university nursing degree (for details refer to temporary provisions of the

Regulation of the Government No.156/2002 Coll. later Regulation of the Government No. 212/2004 Coll. and

then Regulation of the Government No. 742/2004 Coll. about the qualifications for medical profession.)

[Beňušová K. 2004].

The newly determined expectations for nursing qualifications therefore only apply to citizens that never

previously worked as nurses and after the entry of the Slovak Republic into EU have decided or will decide to

train for this medical profession within our territory.

The Slovak Chamber of Nurses and Midwives (www.sksapa.sk) issues a licence to work in a health profession

nurse to citizen who gained or were admitted nursing qualifications, and have applied for this licence.

Should the nurse intends to under her own name and under own responsibility, run their own agency for

home nursing care or nursing home, its vital to submit the licence issued by the chamber to the relevant

(according to the place of the practice) regional authority (best to the nurse of regional authority) with the

application for the running one of the above mentioned healthcare facilities.

The nurse provides basic and specialized nursing care using the method of nursing process. The scope of

nursing practice is stipulated by the Regulation of the Ministry of Health of the Slovak Republic No. 364/2005

Coll., which establishes the scope of nursing practice provided by nurse independently or cooperating with a

doctor and the scope of nursing practice provided by midwife independently or with cooperation with a

doctor.

No detailed information about Slovak nurses competencies have been retrieved.

HEALTH CARE ASSISTANT

The educational curriculums for health care assistants have been regulated nationally (by Government

Regulation 296/2010) and the educational programmes must be accredited by the Ministry.

They provide basic nursing care under the specialized supervision of the nurse and cooperate by specialized

and nursing care in healthcare using the method of nursing process and participate in specialized

administrative and documentation work of healthcare providers.

This study takes place in relevant secondary health schools in the Slovak Republic in a form of full higher

specialized vocational training and the medical assistant is trained to be able to cooperate in basic nursing

activities with the nurse. Considering relevant EU directives on minimal requirements for the content of nurse

training, so far it is not assumed that the medical assistant could take over and independently execute some of

the competencies of the nurse, as for instance blood taking for tests, cooperation by blood transfusion,

catheter insertion in women etc., but he should cooperate with the nurse in complete hygienic care, the

prevention of bed sores, checking the drinking schedule etc. Establishment of this new study will help nurses

with some of their present activities.

No detailed information about Slovak health care assistant competencies have been retrieved.

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Among long-term carers there are those educated for the job and those without such specific training.

A figure named CARER provides PERSONAL CARE: he/she attends full secondary vocational training with a

focus on home care (nursing) and health care or accredited course (220 hours) for carers [Genet et al, 2013].

Most carers employed by municipality are employed with a salary, but some are employed through a work

performance agreement (paid for a certain number of services to be provided instead of hours) [Genet et al,

2013].

FAMILY ASSISTANTS provide DOMESTIC AID, performing activities such as: shopping; accompanying the older

adult to a doctor; appointment; getting medical prescriptions from pharmacies; help in the farmyard, care of

animals, wood chopping; housekeeping (cleaning windows, tidying, food preserving in summer/autumn);

mediation of social contact with peers; going for a walk, companionship, supervision of seniors during the

absence of their family members; ensuring and facilitating contact with authorities (social insurance, health

insurance, post office, ministries); visiting elderly person living alone in hospital [Szüdi et al., 2016]. In 2010

the number of personal assistants was 9,340 (from that 212 were family members) and the number of

untrained informal family carers was 56,434.

No detailed information about Slovak Carer and Family Assistant competencies have been retrieved.

32.2.1 References

Beňušová K. (2004). Education of healthcare professionals in the Slovak Republic, Approved on November

28th, 2005 by the Minister of Healhcare of the Slovak Republic. www.health.gov.sk/

Genet, N., Boerma, W., Kroneman, M., Hutchinson, A., & Saltman, R.B. (2013). Home care across Europe. Copenhagen: WHO, Regional Office for Europe (on behalf of the European Observatory on Health Systems and Policies) http://www.nivel.nl/sites/default/files/bestanden/Home-care-across-Europe-case-studies.pdf Lezovic, M., Raucinova, M., Kovac, A., Dzundova, Z.,Moricova, S., & Kovac, R. The position of home care in the

system of long-term care in Slovakia. Lekarsky obzor 56[12], 514–517. 2007.

Lezovic M., Taragelova B., Beresova M. (2011). Home care in Slovakia. Bratisl Lek Listy 2011-112 (9), pp.488-

490.

Radvanský M. & Páleník V.(2010). The Long-Term Care System For The Elderly In Slovakia. European Network

of Economic Policy Research Institutes (ENEPRI) RESEARCH REPORT NO. 86, 2010. ANCIEN Project website

http://www.ancien-longtermcare.eu/node/27

Szalay T, Pažitný P, Szalayová A., Frisová S., Morvay K., Petrovič M., van Ginneken E., Slovakia: Health System

Review, Published by Observatory, ISSN 1817–6127 Vol. 13 No. 2, April 2011

http://www.hpi.sk/en/category/health-system-in-slovakia/

Szüdi G., Kováčová J. & Konečný S. (2016). Transformation of Social Care Services for the Elderly in Slovakia,

Journal of Social Service. Research, Research, 42:2, 199-217, DOI: 10.1080/01488376.2015.1129016

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33 OLDER PERSONS HOMECARE IN SWEDEN


The Ministry of Health and Social Affairs in Sweden is responsible for general planning, guidance and

supervision aimed at older people. The overall policy is that people have the possibility to live independently

and safely in their own homes as long as they wish with support and home-care if needed. The targets are

established by the Swedish Government and Parliament.

The care of older people, which includes the care of people with dementia, is regulated by three laws. Each

law regulates in a different way what the public sector can expect in relation to the individual and what kind of

rights the individual has. The laws are as follows:

• the Law of Health and Medical Services (HSL) 1982:763;

• the New Social Service Legislation (SOL) SFS 2002:453 (which came into force on 1 January 2002); and

• the Law of Support and Service to Certain Persons with Handicap (LSS) 1994 which is a law of rights

and carefully specifies the obligations of municipalities and county councils as well as individual rights.

Only younger people, under 65 years, with dementia have a right to receive help from a personal

assistant instead of home care.

The HSL includes an obligation of health service authorities to provide home care services if the needs cannot

be met in any other way. Much of the care is carried out by families (informal caregivers). However, there is no

statutory obligation for children to care for or financially support their parents. In the Social Service Legislation

there are rules which state that the municipalities shall give those who need it, i.e. elderly people and those

with disabilities, the kind of support they need which among other things includes home care services. There is

no specific reference made to people with dementia. Moreover, there is no national, legally binding definition

of dependency in Sweden. People with dementia are covered by the categories “elderly” and “people with

disability”. Home care includes medical, rehabilitation and social work which a person may need at home.

According to the SOL, municipalities should support relatives. An important means of support for people with

dementia, to enable them to live at home, is day-care which can provide stimulation and ensure the safety of

people with dementia, as well as providing relief for the relatives. However, day-care is not compulsory.

The municipalities are independently responsible for providing social and home care. Social legislation

provides a legal framework which gives the municipalities freedom to develop the law according to local

conditions and political decisions. They can therefore interpret their obligations differently. Many

municipalities have developed their own informal guidelines on service provision with the result that in some

areas, for example, elderly people who only need help with cleaning are no longer eligible for home-help.

Some have introduced means testing for some services. (Thorslund et al., 2001)


In Sweden, the welfare of the elderly is divided between three levels of government:

• at national level: the Parliament/Government (responsible for establishing policy aims and directives

by means of legislation and economic steering measures)

• at regional level: the county councils (responsible for the provision of medical and health care)

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• at local level: the municipalities (responsible for meeting the social services and housing needs of the

elderly) (Regeringskansliet, 2002)

In 1992, the Swedish government implemented the Community Care Reform (known as the Ädelreform) which

involved the decentralisation of responsibility and resources for the care of the elderly from regional to local

governments. (Regeringskansliet, 2002)

Half of the municipalities, 144 of 290, in the country have now taken over responsibility for health and medical

care in ordinary living. In the other municipalities, the county councils are responsible.

The municipalities are responsible for organising service and home care for their inhabitants. They can provide

services themselves or they can buy from private providers.

The local authorities are obliged to have insight into and keep control of both their own and private type of

care. Support from voluntary organisations is limited. The municipalities are responsible for providing assistive

devices for the elderly.

Since an increasing number of people with dementia remain at home in their usual environment for an

increasingly long period of time during the course of the disease, specially developed care and support

measures are needed that target them and their close relatives. In a number of municipalities, there are clear

plans and strategies for how the municipalities can provide individual adapted care for people with dementia.

In many other areas, both knowledge regarding the needs of people with dementia and their relatives and the

activities and resources offered to meet these needs are insufficient.

The fees charged for home help are determined by the amount of help needed and a person’s income.

Nevertheless, people receiving home care only pay a fraction of the actual cost. Also, since 1 July 2002, there

has been a maximum fee for elderly patients resident in the municipalities. (Regeringskansliet, 2002)

The provision of services is based on an assessment of the person’s housing, services and care needs. This is

usually carried out by a municipal care manager, or as is often the case for elderly people, by an

interdisciplinary care planning team (Johansson, 2004).


Entitlement to aid, insofar as this concerns the care of elderly people, includes amongst other things help in

the home with services and personal care if the needs cannot be satisfied in other ways. The type of home

care provided can be divided into different services which involve practical help with running of the home,

cleaning and laundry, help with purchases and other important errands, as well as cooking and help eating.

Help with care means personal help with tasks which are needed in order to satisfy the person’s physical,

mental and social needs. It may be help with eating or drinking, getting dressed and moving, help with

personal hygiene, activities to break isolation, measures to ensure that the person feels safe and secure at

home, or a safety-alarm (which only people with mild dementia can use). It is possible to get home care and

medical care every day of the week, in the evening and at night. In 1997, 28 percent of those receiving home

help received it in the evenings and at night.

In addition to home help, other municipal services for the elderly include transportation services, foot care,

meals on wheels, security alarms, housing adaptations and disability support, etc. (Regeringskansliet, 2002).


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§29 of the Law of Health and Medical Services HSL and chapter 3, §5 of the New Social Legislation SoL, states

that home care services should be organised in consultation with the people and relatives who are asking for a

special kind of assistance. A decision made in accordance with the social law can be appealed if the decision is

wholly or partially against the person’s wishes.

In 2002, the Government decided to set up a working group to compile the knowledge available about the

situation of people with dementia and their relatives. Its objective was to try to provide a comprehensive

overview of the current situation.

The group has presented a national view of how dementia care has evolved in Sweden during recent years and

the areas that it is important to prioritise and develop in the next few years. This report entitled “På väg mot

en god demensvård” (On the way towards good dementia care) was published by the Ministry of Health and

Social Affairs in 2003. This report has led to a number of different projects in the Municipalities and County

Councils.

There are no national facts about users’ satisfaction but many local studies have been done which show that

people are generally satisfied with home care. General satisfaction is however a blunt measure for services

and care. The failings become much clearer with specific questions. Another problem is that many people

cannot answer the questions because of their disease. Often the questionnaire or interview is answered by the

relative even though users and relatives’ opinions about care often differ. In 2003, the Swedish Dementia

Association published an extensive study of the situation of caregivers.

In studies where users have been asked how important a certain fact is, the answer is very often that having

the same member of staff is important for their safety. A common experience is that staff is in a hurry. There is

no time to talk and be together socially. Questions which are given the highest evaluation are those

concerning treatment and accessibility. It is also important to be aware of the needs of people with dementia

and their relatives and to understand the experience and needs of people with dementia in particular. In some

communities, specially organised home-care for people with dementia has been started.

Support for people with dementia in their own homes varies greatly from one community to the next. In the

inquiry into dementia in 2002, 9% of the communities said that they had specially arranged home care for

people with dementia. In certain cases, there is specific planning and a strategy on how the communities

should treat and give individually designed care to people with dementia. Elsewhere, knowledge about people

with dementia and their relatives is insufficient.

However, a great deal of education/training for staff working with people with dementia has been organised.

Awareness about the importance for staff providing care and support to persons with dementia to have the

requisite knowledge has increased. They have to know how to behave towards people with dementia, how to

stimulate them, what attitude to have when handling challenging behaviour and how to make the most of a

person’s remaining capacity.

33.1.1 References

Information provided by Inge Ploby

Johansson, L. (2004), National Background Report for Sweden, EUROFAMCARE.http://www.uke.uni-

hamburg.de/extern/eurofamcare/documents/nabare_sweden_rc1_a4.pdf

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Regieringskansliet/Socialdepartementet (2002), Answer to questionnaire on health and long-term care of the

Elderly – Sweden, European Commission,

(http://europa.eu.int/comm/employment_social/social_protection/docs/sv_healthreply_en.pdf)

Thorslund, M. et al. (2001), Care for elderly people in Sweden. In Aging: Weisstub, D.N. et al.) (Eds.), Caring for

our Elders, Kluwer Academic Publishers

34 OLDER PERSONS HOMECARE IN UK

34.1 Introduction to older persons homecare service in UK In the United Kingdom healthcare and homecare services are perfectly designed to assist the needs of the

elderly people in their country. It is provided either by NHS or the local Council (or sometimes both). There are

several well based private care providers (AgeUK, Find Me good Care website, etc.) and volunteering groups

(AgeUK or the Royal Voluntary Service), and charity organizations well organized.

There are several regulatory bodies to hold up a good evolution of the care providers (Regulatory Authorities

for Care Homes, Extra Care Housing & Adult Day Care Centers http://www.carehome.co.uk/regulatory-

authorities/ ) and inspection (Care Quality Com-mission (CQC) http://www.cqc.org.uk/content/regulated-

activities ) and any information is easily located in the internet. The CQC is the national independent regulator

of all health and social care services in England. At present they are working on 2016-2021 strategy to make

safe, effective, compassionate, high-quality care and encourage care services to improve. They monitor,

inspect and regulate services and produce reports in regard. (In Wales: the Care and Social Services

Inspectorate Wales). Furthermore, U.K. has established a Local Government Ombudsman, the Adult Social

Services Safeguarding team, and the Equality Advisory and Support Service to investigate any possible

complaint or misunderstanding.

At the first stage of contact, a social care professional from the social services department in all local councils

is in charge of assessment. This assessor (free of charge) will come to the older person´s home and will not

only consider physical safety but also emotional and social aspects of his/her life. Clients are classified as

having needs in one of four categories: low, moderate, substantial or critical. They will decide together with

the elderly the best kind of care or support most adequate to meet their needs. Whether the elderly will have

to contribute for these services or the local council will take charge of their costs depends on the income,

capital and savings of each person. There is a national threshold for eligibility. The council can provide its own

services or give a direct payment to the needed person to fund the services he/she will receive. There are

upper and lower limits for help. Over £23,250 they will have to pay their own fees, named Self-funder; under

£14,250 the city council will fund the costs but the elderly will have to contribute with their pension. (In Wales

£24,000 upper limit and there is now lower limit). Nevertheless, the elderly person is ensured by a Personal

Expenses Allowance.

There is a wide range of home care services: residential care; community cares services; NHS continuing

healthcare; short-term respite services; long-term home care services; occupational therapists; nurses;

volunteers; handy-person; TaxiCard or Dile-a-Ride services for disabled persons; chiropodists; specialist

equipment and adaptations for daily living like walking frames, handrails, bath seats, etc. (if they cost less that

£ 1,000 they are free of charge); Telecare services (to remind tasks, medication alerts, personal emergency

alarms, etc.); personal care services (getting dressed, bathing, eating & drinking, getting around or needing

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someone to watch over the elderly for a few hours, …). The U.K. Care Act 2014 complies rights and duties of

care givers.

As for nursing needs, as of November 2014, there was a lack of 20,000 full-time posts in the U.K. Hospitals are

hiring hundreds of nurses, even not knowing the English language (mostly from Portugal and Spain, because

they are highly qualified and experienced, low-paid in their home country or all the way, into unemployment).

As for Qualification Framework in the U.K., educational pathway is as follows:

• Care Certificate (set of standards developed for non-regulated workers that links to National Occupational

Standards: Understanding your roll; Personal development; Duty of care; Equality and diversity; Work in a

person centered way; Communication; Privacy and dignity; Fluids and nutrition; Awareness of mental

health; Dementia and learning disabilities; Safeguarding children; Basic life support; Health and safety;

Handling information; Infection prevention and control.

• Apprenticeships (work-based learning program leading to nationally recognized qualifications of any age).

Currently there are three levels of social care Apprenticeships (Intermediate Apprenticeship in Health and

Social Care – Level 2; Advanced Apprenticeships in Health and Social Care – Level 3; Higher

Apprenticeships in Health and Social Care – Care Leadership and Management – Level 5). The core

pathway is based on the Level 5 Diploma. As well as taking the core pathway, the option of Higher

Education – Level 5 is available.

o Level 2 HSC Diploma: Apprentice working in domiciliary care; community learning disability; residential

homes; adult residential care; supported housing providing specialist care; end of life care.

o Level 3 HSC Diploma: Apprentice working for learning disability service; personal assistants; in

residential homes; sensory service; community learning disability teams; with individuals with learning

disabilities; brokerage support service; mental health services; working as care worker in adult social

care setting role as end of life care; reablement role in care home or community settings; working in

supervisory role for individuals with dementia; working as infection prevention and lead in a care

home setting; in autism services.

o Level 5 Diploma: for leadership for health and social care, and children and young people´s services for

Adults residential management pathway; for Advanced practice pathway and Commissioning

procurement and contracting for care services).

o Level 7 Diploma in Commissioning procurement and contracting for care services.

• The requirements of the European Directives 77/453/EEC and 89/595/EEC apply to all nurses undertaking

programs for adult nursing. The Nursing and Midwifery Council (NMC) registers all qualified nurses in the

U.K. Educational programs are designed in accordance with EU agreements and comprise a Common

Foundation Program (CFP) of 12 months for students aiming to enter all branches; this is followed by a

branch program of 2 years in adult nursing, mental health nursing, learning disabilities nursing or

children's nursing (for full-time programs). The balance of learning and teaching activities is 50% practice

and 50% theory in both CFP and branch programs.

Regulatory bodies:

- General Social Care Council

- Nursing and Midwife Council

- Health Professions Council

- Care Quality Commission (CQC)

- Independent Safeguarding Agency

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Actors in home care:

- Department of Health of England

- Stragetic Health Authorities

- Care Quality Commission

- Local Authorities

- Primary Care Trusts

- Home Nursing and Domiciliary Care provider agencies

- Local Housing providers (“Extra-care” housing)

- Skills for Care. (Company that develops educational and practical skills frameworks and assist training

of overall non-professional social care workforce)

- Voluntary and Charitable (third Sector) organizations

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34.2 HHCP involved in older persons homecare service in UK: roles and competences


(SET OF ACTIVITIES)

KNOWLEDGE


SKILLS


COMPETENCIES

know how to be

HHCP1 Domestic Staff (Level 0)

No qualification required although Common Induction

Standards (CIS) are encouraged. Care certificate

will replace CIS diploma.


To know basics on how to

do housework.

To keep hygienic conditions of

the customer´s personal

environment.

To use cleaning products in a

proper way


To know basics of hygiene

in home environment

(cleaning, food etc.)

To remove risks on not

keeping the house clean

To evaluate risks while

keeping the hygiene of the

home environment

To take action to reduce the risks of unclean environment.

Health monitoring To know basics physical and mental health conditions



To take action to reduce the risks

To be patient with mentally or physically disabled

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To do grocery shopping

To be motived to give advices about food to buy on the basis

of economic availability and food needs To know basics of nutrition




To have a basic knowledge regarding physical and

mental conditions of older adults during

accompaniment (falls risk assessment)

To accompany when going out Ability to overhaul the older adults conditions before and during the accompaniment


To promote socialization Ability to evaluate and assess

a socialization process


To have basic knowledge of disrespectful or

inappropriate circumstances



To take action to reduce

unethical situations To reinforce equality, diversity and transcultural approaches

HHCP2 Day care worker, homecare worker, personal assistant, other staff in caring roles,

support workers and volunteers. National

Vocational Qualification


To know about home

environment safety

To report environmental risks

(to whom, how, with what

times)

To guide ways of avoiding

risks on home environment

safety

To know good hygiene

habits in home

environment (cleaning,

To report hygiene risks (to

whom, how, with what times)

To evaluate appropriately the

risks of unhygienic home

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(NVQ) (Level 2 & 3) food etc.) environment



Health monitoring

To know the main indicators of risky conditions for physical and mental health (sudden illness, accidents, spread of infection, etc.)


To properly evaluate a mental and physical risk in home environment


To have a patient attitude in order to develop good habits

To know how to help in medication adhesion

To provide planning schedules as reminders of medication

To interact for healthy behaviors in medical prescriptions

Equipe working










To know the role of the social worker

To be able to respect social workers´ indications

To encourage the elderly to communicate with the

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network








To know the importance of privacy

To keep privacy about customer´s reports

To respect the elderly person´s decision


Domestic economy

Grocery shopping Assessing foods to buy on the basis of economic availability

and food needs Basic knowledge of nutrition




To Know physical and mental conditions of older

adults during accompaniment (falls risk

assessment)

To Accompany when going out

Ability to overhaul the older adults conditions before and during the accompaniment

To know how to identify, respond to and escalate

changes to physical, social and emotional needs

To report changes to the correct professional , (to whom, when and where)

To motivate readaptation of the elderly person after

changes

To have basic knowledge of Socialization process

To know how to evaluate and assess a socialization process

To have the ability to promote socialization

To know local and national strategies for safeguarding



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and protection from abuse To report abuse (to whom,

when and where)

To know the barriers to communication (non-

verbal communication, importance of active

listening, etc.)


To establish ways to communicate with the

individual. (Establish signs, gestures, marks,

communication boards, etc.)

HHCP3- Therapists Chair based exercise qualification

(Level 2) Activities for chair based exercise

To know basics on physical

anatomy

To know how to provide chair

based exercise for frailer older

adults and disabled adults

To have the ability of

identifying erroneous

treatments.




HHCP4 -Specialist in Older adults with dementia

(Level 2 & 3)

Activities for older adults with

dementia

To know how to be aware of dementia

To report risks of dementia in older people (to whom, when and where)


To know the factors that

can influence

communication and

interaction with individuals

who have dementia

To know how to cope with

individuals with dementia

To treat individuals with

dementia under equal rights



conditions

To encourage the elderly person to entitle respect for

his/her personal values

HHCP5 - Specialist in Diabetes (Level 2 & 3)

Activities for older adults with diabetes

To know how to be aware of older people with diabetes

To know to report a risk of diabetes (to whom, when and

where)

To know how to prevent diabetes and/or early

detection

To know the importance of privacy

To keep privacy about customer´s reports

To encourage the elderly person to entitle respect for

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his/her personal values

HHCP6 - Specialist in Awareness of End of Life (Level 2, 3 & 5)

Activities to support individuals during the last days of life


To understand advance care planning

To know how to support individuals with loss and grief before death and/or specific

communication needs To know the importance of privacy To keep privacy about

customer´s reports

HHCP7 - Specialist in Seated recreational Physical Activities (Level 2) and Stroke Care management (Level 3)

Activities concerned with specified physical/mental injuries

To know basics on physical anatomy

To know how to cope with specific health injuries

To provide positive feedback to avoid doldrums or

depressions

HHCP8 - NVQ Health and Social Care (level 4) and Registered Managers Award (Level 4) aimed at managers of care services (MIS Award). Leadership for Health and Social Care (Level 5)

The roll is the same as HHCP2

mainly to develop broader skills

and knowledge as: Community

Care/Support Officer, Care

Assessment Officer, Social

Services Officer, Occupational

Therapy Assistant, Physiotherapy

Assistant, Independence Support

Assistant, Telecare Assistant,

Social Care Assessor, Community

Care Assessment Officer, Social

Care Assistant, Brokerage

worker, Occupational

Assessment Officer,

Rehabilitation and Re-ablement

To know the aims of each

service provided

To evaluate correctly the

service provided

To take an active part in

profitable teamwork

To know the needs of each elderly person under charge

To organize the best plan for each individual

To reflect on own work practices

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http://www.skillsforcare.org.uk/Document-library/Qualifications-and-Apprenticeships/Adult-social-care-qualifications/Guide-to-qualifications-and-standards-in-

adult-social-care-201415.pdf

Assistant, Re-ablement support

worker/officer, and Assistive

Technology Co-ordinator/officer

To know all the services that can be provided

To fit services with specific needs

To be an active listener to carers remarks as well as to customers´ complaints

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35 OLDER PERSONS HOMECARE IN SWITZERLAND

35.1 Introduction to older persons homecare service in Switzerland

Homecare in Switzerland is not officially regulated. Swiss Federal Law on Health -1996, 101bis article-

determines that the Swiss government must subsidize homecare services for elderly, but it gives cantons most

responsibilities to plan and provide these homecare services.

The following demographic statistics are from Ireland's Central Statistics Office (CSO), Eurostat and the CIA

World Factbook.Population:061,516

Age structure

65 years and over: 17.5% (male 616,009/female 798,419) (2014 est.)

Median age total: 42 years

a) male: 41 years

b) female: 42.9 years (2014 est.)

Sex ratio

65 years and over: 0.76 male(s)/female

total population: 0.97 male(s)/female (2014 est.)

Life expectancy at birth total population: 82.39 years

a) male: 80.1 years

b) female: 84.81 years (2014 est.)

Figure 27: Population in Switzerland - 2014

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In Switzerland, there is a balanced rate of male and female older people taking care of elderly. These care

providers are not considered workers with a very high status.

The payment for homecare, even though the State bears subsidiary liability, is done by elderly and their

families. Whenever these are unable then the State intervenes. At present there is a lack of political concern

about economic and social aspects aimed at normalizing homecare services for elderly people in the country.

The payment to care providers is done in a variety of ways, using several means of payment, such as copay

depending on the annual income of the elderly, prevailing the private homecare provider.

At present there is a debate as to which is the adequate financial assistance of the initiatives in favor of elderly

care, promoting strategies to increase the involvement of relatives in the homecare provision.

Assistance nurse, home help assistance, personal assistant, nurses, home help officer, and informal caregivers

HHCP are involved in older persons homecare service .

Nurses in Switzerland have basic knowledge of health issues and of prevention, diagnostic, therapeutic,

palliative and rehabilitation measures; they also have abilities on clinic reasoning, they are able to search and

integrate information for their professional practice, they can give advice on health issues to patients. As for

their capabilities, they are able to take responsibilities for their actions and respect their limitations, are

autonomous in their work, are able to solve problems, communicate and participate in development, promote

health and prevent illnesses.

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35.2 HHCP involved in older persons homecare service in Switzerland: roles and competences

Occupation Role EQF

Knowledge



Skills



COMPETENCIES

know how to be -.

Assistant nurse

3-4

Three year upper secondary school education.

Responsibility Cooperation Management Work environment

Home help

assistant

3-4

Three year upper secondary school education

Provide home help services i.e. domestic aid and personal care (bathing, dressing, etc.). Activities such as socializing or going for a walk.

Personal assistant 3-4

Short course focused on the role of being a personal assistant. Often the person has a three year upper secondary school education.

Provide home help services i.e. domestic aid and personal care (bathing, dressing, etc.). Activities such as socializing or going for a walk

Nurse 6

Know the legal bases and the priorities of the Health Policy of the Swiss System of Health on care and social protection as well as

Know how to develop a career being respectful with legal grounds with efficacy. Adequate medicine administration.

Capability of playing a role within the health system which guarantees the quality of attention and the best practice.

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direction principles and its limits. Scientific knowledge to be able to take preventive, diagnostic, therapeutic, palliative and rehab measures. Knowledge of determinants that keep and favor the health of individuals and population, and those capable of inhibiting the measures which contribute to improving the quality of life.

Instruction in scientific search methods within the domain of health, applying evidence based practice. Keeping clinical reasoning and their attitude to develop the necessary measures depending on the type of occupation and support. Being capable of participating in the search and integration of relevant and concluding information for the professional practice Giving advice to patients and companions on health issues based in updated scientific knowledge and in ethical principles.

Capability of being responsible of own actions and assuming own limitations. Capability of being autonomous within the professional activity. Capacity of active search of an inter-profesional activity and cooperation with Health System. Capacity to develop understanding during assistance and, when necessary, to problem solving. Ability to communicate with groups of patients and professionals about specific care. Ability to participate in the development of the promotion of health and illness prevention.

Home help officer 6-7

Three year

Including education in management and service assessment.

Responsible for the assessment of home help service.

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education at

university level.

Has to make sure that indicated home help service is being provided

Informal

caregivers 1-2

Respite via short-term care. Respite via day activities. Respite in the own home. Individual talks. Family support group and centres. Educations and recreation. Well-being activities are available for informal carer (ibid).

35.2.1 References

Danielsson M. Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study. BMC Nurs [Internet]. 2014;

Recuperado a partir de: http://bmcnurs.biomedcentral.com/articles/10.1186/s12912-014-0039-5

Nilsson G. The subject pedagogy from theory to practice - the newly registered nurses view [Internet]. Lund University; 2008. Retrieved from:

https://www.google.es/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&cad=rja&uact=8&ved=0ahUKEwjJyrrCsurLAhUBfRoKHfqVAJoQFghJMAU&url=http%3A%2F

%2Fwww.med.lu.se%2Fcontent%2Fdownload%2F77088%2F549223%2Ffile%2FProjektBodilIvarsson2.pdf&usg=AFQjCNGuhz_n1M39K3XVKT8MXEV-

RCJCbw&sig2=rvkhJcMIg8bEARQGNFh3fw&bvm=bv.118353311,d.bGs

Final project skills Professions HES health. Appendix I. http://www.hes-so.ch/data/documents/projet-competences-finales-professions-sante-HES-annexe-718.pdf

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36 OLDER PERSONS HOMECARE IN NORWAY

36.1 Introduction to older persons homecare service in Norway

Legislation relating to home care services

People in Norway are not legally obliged to provide care for their parents.

National legislation obliges the health and social services to provide home care services to those who need

them. However, there is no specific reference to people with dementia.

Act no. 66 of 19 November 1982 on Municipal Health Services describes the duties of the health services as

follows:

1. The promotion of health and prevention of illness, injuries and physical defects

2. Diagnosis and treatment of illness, injuries or physical defects.

3. Medical rehabilitation.

4. Nursing and care outside health institutions.

The municipalities have to provide the following services:

1. General medical practices

2. Physiotherapy

3. Nursing, including home care services.

The municipality shall plan, organise and provide the services regulated in the law. The people receiving care

shall:

• feel safe, respected and have a foreseeable situation

• be able to take care of themselves as long as possible

• have their basic physical needs taken care of

• receive adequate help with meals and have enough time to eat in peace

• receive help with personal hygiene and bodily functions

• receive help, if needed, to dress and undress

• be able to follow the natural rhythm of the day, avoiding unwanted stays in bed

• have the possibility for privacy and self-determination

• be able to have social contact

• be able to participate in suitable activities both indoors and out of doors

• have necessary medical check-ups, treatment, rehabilitation and care

• have necessary dental check-ups and treatment (Axel Wannag, 2000).

Act no. 81 of 13 December 1991 on Social Services, Chapter 1, Section 1-1, states that the purpose of the Act

is:

Deliverable 2.1


• to promote financial and social security, to improve the living conditions of disadvantaged persons, to

contribute to greater social equality and to prevent social problems.

• to ensure that each individual has the possibility to lead an independent, active and meaningful life

together with others.

Chapter 4, Section 4-1 describes the aims of social services as being to provide information, advice and

guidance in order to resolve or prevent social problems. If the social services are unable to provide such

assistance, they must, if possible, make sure that others do.

The Social Services consist of (section 4-2 in the Act):

The Social Services consist of (section 4-2 in the Act):

• practical assistance and training to people who need it due to illness, disability, age or for other

reasons

• short-term care in order to relieve carers with a particularly heavy burden

• support to individuals and families who need it due to disability, age or social problems

• institutional care for those who need it due to disability, age or other reasons

• financial aid to carers with a particularly heavy burden.

Organisation and funding of home care services

Home care services for the elderly and disabled are organised, managed and financed by the municipalities.

Users may have to pay a fee for some of these services. The size of the fee varies from one municipality to the

next.

Most of the municipalities (80%) offer services 24 hours a day. Approximately 155,000 people received home

care services in 1999 (European Observatory on Health Care Systems, 2002).

"Report No. 20 to the Parliament (1996-97), Plan of Action for Care of the Elderly; Security - Respect - Quality"

is a four-year plan of action for nursing and care services run by the local authorities. The main aim of this plan

was to develop local services for nursing and care by:

aim of this plan was to develop local services for nursing and care by:

• providing services that ensure the elderly a secure and, as far as possible, a fulfilling and independent

life;

• enabling the elderly to live in their own homes as long as possible;

• making sure that the services have sufficient capacity

This was achieved through general guidelines including:

• ensuring high-quality nursing and home care services

• developing an integrated, flexible range of services

• providing equal facilities nationwide, independent of a person’s place of residence, income or

resources

• ensuring greater participation and freedom of choice to service users.

Deliverable 2.1


According to Ingebretsen and Eriksen (2004), the goals of this action plan, which include the strengthening of

home-based care, have to a large extent been achieved, albeit with considerable regional variations. This has

led to more home-based care. It should be noted, however, that Norway is a very sparsely populated country

with great variation between municipalities in terms of socioeconomic structure, population etc.

The provision of services is based on a person’s needs regardless of whether they live alone or with a

spouse/family. In this way, the assessment is based on the condition of the person requiring assistance and

not on the ability or willingness of relatives to provide services or meet needs. In practice, however, elderly

people living alone are sometimes given priority. (Ingebretsen and Eriksen, 2004).

In June 1998, the Norwegian parliament adopted the National Programme for Mental Health. Implementation

of this programme started in 1999 and will run until 2008. A document entitled “Mental Health Services in

Norway – prevention, treatment, care” produced by the Norwegian Ministry of Health and Care Services can

be found at: http://odin.dep.no/filarkiv/233840/MentalHealthWeb.pdf


Home care services typically include:

• Leisure activities

• Assistance handling personal finances

• Ensuring that medication is taken

• Housework

• Cooking

• Shopping

• Personal hygiene

• Getting dressed and undressed

• Technical aids

Day care centres exist but are not statutory.

Rehabilitation

Lately, there has been an interest in the project ”every – day – rebahilitation”, which some communes have

adoptes from rehabilitation – prosjects in Denmark and Sweeden. This impies a stronger emphazis on

personell with rehabilitation – skills, and it gives the whole personell – group involved an opportunity to work

whith the patients in a slightly different way. It also empowers the patients, as one of the core aim is to enable

the patienst to reach their own, selfdefined goals of rehabilitation in the every – day life.

Recruitment challenges

The shortage in health and social personnel in Norway is being met in many ways, some of which the trade

unions are highly sceptical to. Stong, multinational recruitment companies bring in people from abroad. The

salaries, pensions ( if they have any) and working conditions are some times below the standards that are set

in the central agreements and the conditions, for example working hours, are often way beyond the limits set

by our Working Enwiroment Act. Norway is dependant on these very able and hard working people, also

within the health and care sector. It is a great shame that they are often offered working conditions and places

Deliverable 2.1


to live, that are below standards and regulations, and the trade unions should intensify our efforts to set this

straight.

There are a large number of enrolled nurses in the age group of 55+, and the recruitment of young people is

low. In addition, Norway expects a high rise of old people in the near future. We need to encourage young

people to choose the health sector.

The Collaboration reform

There has been a lot of discussions related to a major reform move that was implemented some years ago.

The aim is, amongst other beneficial goals, to ease off the pressure in the health services, especially within the

hospital services. The reform draws up some general lines;

• Preventive actions; less sick people, less pressure. To be able to prevent; all sectors must collaborate.

• More (even more) responsibility to the local municipals, increased medical care in the local

community, less entries to hospitals, quicker (even quicker) transfer back home from hospitals for

non-surgical patients ( of whom many are the very old patients).

• More funding to the local communities, due to the increase in responsibilities and tasks.

• More collaboration across sectors (horizontally) and between sectors (vertically; i.e. hospitals and

the local community).


Although no specific reference is made to people with dementia in the National Programme for Mental Health,

reference is made to the ICD classification F00-F009 (organic, including symptomatic, mental disorders). The

report emphasises the importance of the patients’ perspective (referred to in the report as the “user”):

“Fundamental for the reform of mental health care in Norway is the emphasis placed on the users’ views and

perspectives on services. The experience and knowledge possessed by users and their relatives, is unique and

necessary in improving and optimising services and treatment. Participation is also vital for empowerment and

for the ability to master one’s own life. This is of great value and a central vision of the National Programme

for Mental Health.

Users and close relatives should be involved at all levels in the decision-making process. At the system level

this implies organised participation by users and relatives in planning processes, legislation, implementation of

treatment programmes etc. It is of major importance that users’ perspectives are taken into consideration in

decision-making throughout the services (political, administrative and professional) and at all levels (Ministry,

municipalities, hospitals etc.). Accordingly, national as well as local authorities should be co-operating with

users’ organisations and unions in these matters. At the individual level, the policy implies a legal right to

participate in the management of necessary services.” (Norwegian Ministry of Health and Care Services, 2005,

p.6)

It is further stated that patients’ needs must guide the provision of services and that cooperation with patients

and their families is required at all levels.

Deliverable 2.1


36.1.1 References

Anonymous, Security – respect – quality, Action plan for care of the elderly 1998 – 2001, Health Care Systems

in Transition, HiT Summary, Norway, European Observatory on Health Care Systems,

http://www.observatory.dk

Information provided by Inger Jorun Edvardsen and Maija Juva

Ingebretsen, R. & Eriksen, J. (2004), National Background Report for Norway, EUROFAMCARE,

http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_norway_rc1_a4.pdf

Ministry of Health and Social Affairs website (http://odin.dep.no/hod/engelsk/publ/handlingsplaner/030005-

990070/dok-bn.html)

Norwegian Ministry of Health and Care Services (2005), Mental Health Services in Norway, prevention –

treatment – care, Helse- og Omsorgsdepartementet

(http://odin.dep.no/filarkiv/233840/MentalHealthWeb.pdf)

Wannag, A. (2000), Caring for the carers; a review of issues (notes from

conference),http://www.phcttb.org/projects/Qualityofcare.htm- accessed on 29/4/2005

36.2 HHCP involved in older persons homecare service in Norway: roles

and competences

The three main personell – groups working in the home care sector are; nurses, practical nurses and assistants

( workers without training whithin health services). The nurses and to some degree the practical nurses have

quite an independant professional role in the health- and care services in patients homes.

” Home” can vary from the ordinary, old hom of the patient, to special care block of flats ( with varied degree

of care, from none to perosnell stationed in the block). Patients who are in great need of support from the

services, but who are not yet entitled to/ in need of nursing home,often live in small flats or rooms that are co

– located with a nursing home. They may receive services from the same personell as those who work in the

nursing home/institution. And they more often have a closer follow – up by doctors, than patients living in

their ordinary homes.

In addition to the above mentioned three personell groups, physiotherapists, occupational therapists and

doctors also provide home services sometimes. This, however, varies a lot from one communtity to another. It

also varies as to where in the ”care – ladder” the patients live.

Practical nurses are on level 4 in the EQF system , nurses are on level 6, (if they heve a masters degree they are

on level 7). The assistants are placed on level 3.

Deliverable 2.1


37 OLDER PERSONS HOMECARE IN ICELAND

In 2015 there are almost 33.000 senior citizens in Iceland. About 11% (3.630) require admission to a nursing

home. According to the literature that is expected to 10,8% of birth tunnel 67 years and older is in need of

assistance.

Today there are waiting list for senior citizens to get a nursing home. They need to go through the evalution

and Rai have reached very ill to enter. That has changed in recent years to increase has been detached and

lengthens the waiting list considerably.

The Icelandic authorities are aware of aging in European countries where the birth rate has reduced impact on

population trends. Life expectancy changes as the improved living conditions and better medical service and

medicines.

Momentum aging rapidly increased after 2000 as shown in the lower spreadsheet, especially with women.

Population forecast for half the increase in the next 50 years.

In general, life expectancy has increased but the service does not follow trends recovered quickly enough.

There is a need for increased funds in the issue, however, the authorities try to do their best. Worth noting

that recessions has been in the country since 2008 which affects the allocation of funds in health care system.

If we turn our focus to the human resources of the nursing home and their education that´s how this country

for Practical Nurses are a small minority of staff who work in nursing home. Unfortunately nursing home

employ unskilled workers receiving the lower wages.Possibly this is done to save the labor cost and no

restricions for skills. Unskilled workers are foreigners who do not speak good Icelandic and this workers have

little or no knowledge of nursing the eldery. some of them are social workers who have college education

(félagsliðar) or foreign unskilled labour.

Only 1/3 of employees of nursing homes in Iceland are Practical nurses. 2/3 eru unskilled workers or staff who

have few courses from Union Promotion (Efling) or low levels of educations. A large part of unskilled workers

are foreigners who have moved to Iceland to get work and speak very poor Icelandic if any. Most come from

Poland, eastern Europe and Asia. Some of the workers adapt well and learn the language and go to school and

pick up health degree. But others have even a university degree from their home lands and work on other

fields due to lack language.

To give a realistic picture of proportion skilles as an example, figures from the human resources deparment

three largest nursing home in Iceland (Grund, Eir and Hrafnista) indicate only 40 Practical nurses in 26

positisions and 99 in 57.75 care positisions. On nursing home Grund, is 33 practical nurses in 23 positisions and

134 unskill workers in 86.36 positisions. These figures show clearly that the Practical Nurses are only 25% of

the staff in nursing homes. It should be noted that the staffing is understaffed and have heavy work load

which increases the strain on the staff.

Deliverable 2.1


Figure 28: Population pyramid of Iceland in 2007 and 2050 ( Statistics Iceland)

Figure 29: The number of eldery age group.


According to the “Icelandic National Health Plan to the year 2010” published by the Ministry of Health and

Social Security in 2004, “With the appropriate services and support it is fair to assume that more people would

be able to stay longer at home. (…) It is important to emphasise the need to maintain and enhance physical

and mental abilities, in order for senior citizens to be able to stay as long as possible in their own homes.”

Methods to achieve this are outlined. These include:

• the need to strengthen and increase cooperation and coordination of home help and

• the need to increase the availability of day care and health centre home services, in which the

emphasis should be on round-the-clock, 7-day service and short-term hospitalisation.

Deliverable 2.1


The Ministry has set itself a target, namely that by 2010 “more than 70% of citizens over the age of 80 will

retain their health to the extent that they can with the appropriate support services, continue to live in their

homes and participate in daily life.


In Iceland, there are a few laws which specifically deal with issues related to the elderly. The first was enacted

in 1982 and was then revised in 1989 and 1999. The underlying principle of these laws is that the elderly

should be respected. The laws also state that the elderly have a legal entitlement to the services that they

need and that consequently the state must ensure that their needs are met in a way that is relevant and

economically feasible (Jónsson and Pálsson, 2005).

The purpose of the Act on the Affairs of the Elderly, No.125 of 31 December 1999 (Act no.125 of 1999) is

stated as being “to ensure that the elderly are able, for as long as possible, to enjoy a normal domestic life and

that they are assured the required institutional services when needed.” An elderly person is defined as being a

person aged 67 or older.

This legislation, combined with the high cost of nursing home care and the desire of many elderly people to

continue living in their own homes, has resulted in an increased demand for home care services (Johnson and

Olafsdottir, 2005).

Home care in Iceland includes health care and social services. The former is in the hands of health care centre

employees pursuant to the Act on Health Care Services. The latter is handled by municipalities or the parties

with which the municipalities have contracted, pursuant to the Act on Municipal Social Services.

Organisation of home care services

In each health care centre district there is a service council for the elderly. This service is responsible for

ensuring that the elderly receive the services they need, that they are informed of the options available to

them and that their needs for institutional care are assessed (Act no.125 of 1999, article 8).

Home nursing services are usually provided by community health centres. Such care is organised on a regional

basis. Other kinds of home care services (sometimes referred to as homemaker services) are organised by the

social services sector, also on a regional basis.

Financing of home care services

The national health insurance finances home nursing care almost entirely. It is paid for by the state through

the central government’s budget. Social services for the elderly (including home care and days care) are paid

for by county councils which are funded by local governments. Nursing in the home is therefore free. Payment

for other home care services is related to income. Therefore, clients may have to pay a small contribution

towards the costs of such services. There are no cash benefits for home care.

People attending day care centres must pay up to a maximum amount of one full basis pension (i.e. EUR 217

per month) (MISSOC, 2005).

People who are in need of care can obtain a reimbursement for care costs along with their pension provided

that they are on a very low pension. If eligible, the amount is calculated on the basis of each individual case in

Deliverable 2.1


terms of percentages (35%, 70%, 90% or 120%) and paid to the person withdementia. In July 2001, this

amounted to EUR 75, EUR 149, EUR 192 and EUR 256 respectively.

Spouses my be entitled to special compensation amounting to 80% of the flat rate state pension for providing

care at home if they:

• have suffered a loss of income as a result of stopping full-time employment;

• have incurred extra expenses linked to day care or paid home help;

• are on a low income e.g. if the spouse has no income.


Chapter IV, article 13 of the Act no.125 of 1999 provides the following examples of geriatric services (which

would also be available to elderly people with dementia).

• Home care services provided to the elderly residing at home. The service shall be based on case-by-

case assessments of service needs and shall be geared to support for self-help. Home care services

shall be provided in the evening, at night and on week-ends if necessary. An effort shall be made to

organise and co-ordinate the health care and social aspects of the home care services with the welfare

and needs of the elderly person in mind.

• Service centres for the elderly which are operated by municipalities to ensure that senior citizens are

provided with company, nourishment, exercise, recreation, entertainment and health surveillance.

Service centres may work independently or in connection with other services enjoyed by the elderly.

• Day-care centres for the elderly as a supporting measure for those who require supervision and care

on a regular basis in order to continue to live at home. Day-care centres for the elderly shall provide

nursing services and be fitted with facilities for exercise and medical services. Transportation services

shall be provided to and from the home of the individual, as well as health assessments, exercise,

recreation, social support, education, counselling and assistance in the activities of daily life.

• Serviced apartments for the elderly which may be privately owned, rented or residential rights

apartments. Prior to the construction of serviced apartments for the elderly, construction permits

must be obtained from the Minister for Health and Social Services pursuant to Article 16. Serviced

apartments for the elderly shall be fitted with security systems and a choice of varied services, such as

catering, laundry and cleaning and access to social activities. Payment for services provided shall be

governed by the provisions of Article 20. The residents of serviced apartments shall be entitled to the

same home and watch services as other residents of the municipality.


The “Icelandic National Health Plan to the year 2010” mentions the objective of ensuring that every health

care institution establishes a formal quality development procedure and follows its own plan with regard to

quality issues and that over 90% of patients should be satisfied with the health care services they receive. It is

not clear to what extent this would apply to the provision of home care services for people with dementia.

37.1.1 References

Act on the Affairs of the Elderly, No.125, 31 December 1999 (with amendments up to Act

No.38/2004),http://eng.heilbrigdisraduneyti.is/media/Laws%20in%20english/Act_on_the_Affairs_of_the_Elde

rly.pdf#search='Act%20on%20the%20Affairs%20of%20the%20Elderly%20AND%20Iceland'

Deliverable 2.1


Alzheimer Europe (2001), Equality in the Provision of Care at Home, Alzheimer Europe

Health information Unit of WHO Regional office for Europe, Highlights on Health in

Iceland,http://www.who.dk/document/E72496.pdf

Johnson, P. and Oafsdottir, T. (2005), WHHO-Compendium Text (extract on

Iceland),http://www.nahc.org/WHHO/WHHOcomptext.html

Jónsson, P. V. and Pálsson, H. (2005), Toward informed and evidence-based elderly care: the RAI experience in

Iceland, http://www.milbank.org/reports/interRAI/Iceland.html

MISSOC (2005), Comparative tables:

Iceland,http://www.europa.eu.int/comm/employment_social/missoc/2002/is_part12_en.htm

The Ministry of Health and Social Security (2004), The Icelandic National Health Plan to the year 1020,

abridged version,

http://www.heilbrigdisraduneyti.is/media/Skyrslur/heilbenska5mai.pdf#search='Icelandic%20National%20Hea

lth%20Plan'

Erasmus Plus – SSA 2015 CARESS Project 382

38 Annex 1: Questionnaire targeting HHCPs

ERASMUS PLUS 2015


AGREEMENT No. 2015 – 3212 / 001 – 001


WP2 – PRIMARY DATA GATHERING

QUESTIONNAIRE

TARGETING HHCPs

Annex to D2.1


PREMISES

The questionnaire should be implemented through an online tool that should be defined by the

consortium.

The online tool should allow for the management of “customized” items thanks to the possibility

of using “conditioned items”, i.e. items that appear/not appear on the base of the answer given to

a previous item.

As defined by the Consortium, the questionnaire will be characterized by:

- a “core” of items that should be included in Italian, Spanish and Finnish questionnaire (IN

BLACK);

- optional items which can be included in the questionnaire (as optional) or not (IN RED)

- specific context-related answer options, which could be included only in some countries; in

order to provide examples, this draft includes possible answer option for Italian context in

purple text, for Finland in green and for Spain in blue.

INTRODUCTIVE TEXT FOR THE USER

“Dear professional,

Thank you in advance for helping us in collecting data about homecare service in Italy. Your

collaboration is very precious in order to support the CARESS European Project trying to improve

the service both at International and local level.

What we’re asking to you is to answer to few questions concerning your activity as a professional

in the field of older adults homecare. Please, answer describing the ACTUAL activity you carry out

while acting as a PROFESSIONAL in OLDER ADULTS HOMECARE. The questionnaire is anonymous

and no professional evaluation will be carried out on the collected data.

You can fill-in the questionnaire in more-times, by saving the answers already provided.

Thank you again for your collaboration ”

SECTION 0: WHAT PROFESSIONAL ARE YOU?

0.1 Have you carried out an older adult homecare activity in the LAST 5 YEARS?

1 Yes [continue the questionnaire]

2 No [stop here]

2.1 Which is your profession?

[Please select only one of the following options]

1. Nurse

2. Physiotherapist


3. Psychologist

4. Educator

5. Home care assistant/ home helper

6. Other [specify_______________________________________]

7. Practical Nurse

8. Occupational Therapist

9. Dietitian

10. Speech therapist

11. OSS – Social Health Operator

12. Social Guardian

2.2 Which of the following contexts represent your activity as practitioner in homecare?

1. Public institutional homecare provider

2. Private homecare provider

3. Freelance professional activity

4. Other [specify_______________________________________]

2.3 Please specify your birth year

[____________________________________]

SECTION 1 – YOUR ACTUAL ACTIVITY AS A PROFESSIONAL

In this section of the questionnaire we will focus on your ACTUAL activity as a professional in

homecare, what really happens when you provide your service at the older person’s own home.

You should list the activities you normally carry out, the needs you address and the

competencies required by these activities and needs.

1.1 Which of the following activities do you normally carry out at the older person’s home?

[Please select all of the activities you normally carry out - more than one choice is possible]

CLINICAL ACTIVITIES RELATED TO ASSESSMENT AND PLANNING

1. evaluation of customer needs

2. evaluation of health condition

3. in-home health exams (e.g. taking blood sample)


SOCIAL/ENVIRONMENTAL/EDUCATION


5. companionship


7. Home Environment assessment

8. intervention for a proper prescription and use of principals devices in home environment


SUPPORT TO INDEPENDENCE



12. Support to daily activities (shopping, going to a medical appointment, etc.)

CLINICAL ACTIVITY RELATED TO THERAPY

13. prevention interventions


15. pharmacological treatment and homeostasis maintenance, performance relating to

excretory functions and skin treatment



CAREGIVER

18. educational interventions for caregivers

TEAM/REPORT

19. team meeting and contacts with the other professionals involved in older person’s

assistance

20. report of the activities conducted

21. Other [specify_______________________________________]

1.2 What is the average time ACTUALLY spent at the older person’s home in your daily activity?

1. Up to 15 minutes

2. From 15 to 30 minutes

3. From 30 min to 1 hour

4. From 1 to 2 hours



7. Other [specify_______________________________________]

1.3 How many times on average do you visit the same older person’s in a week?

1. Once


2. From 2 to 3 times



5. More than 7 times

1.4 Let’s focus on the needs of the older person. Which of the following possible needs to do you

normally address in your daily activity? [Please select all of the needs you normally address - more

than one choice is possible]

Need for BASIC PERSONAL attention

1. Need to be supported in hygiene including shower or bath or oral hygiene

2. Need of assistance for dressing up and undressing

3. Need of assistance for transfers and mobilization at home

4. Need for a proper maintenance of the house including cleaning and order washing, ironing

and organization of the clothes inside the home

5. Prevention of skin lesions through proper hygiene, postural changes and specific skin care.

6. Specific care of urinary and fecal incontinence.

7. Need of support and assistance in food management including preparation meals and

purchase of foods

8. Need of basic maintenance of household appliances and the ones of personal use,

including protection and security review tasks of housing (ventilation, gas, electricity ...).

9. Need of support and assistance to accomplish administrative procedures including those

relating with health.

10. Need of support for the management of technological devices for home health monitoring

11. Need of support in mobility out of home

Need for BIO-PSYCHO PHYSICAL HEALTH support.

12. Need of protection and promotion of the psychological and emotional welfare and

protection 13. Need of assistance to avoid situations of loneliness and isolation and facilitate family and


14. Need to be supported in the self-management of his/her physical health.

15. Need to be supported in the self-management of his/her mental health

Other needs in situations involving particularly PREVALENT DISEASES in aging.

16. Need to be supported and educated in proper positioning and postural changes to prevent

physical disorders

17. Need to feel safe and secure in his/her surroundings including suitability of the home to

prevent "static causes "of falls (assistance in removing barriers and adaptation of the

home).


18. Need of support and rehabilitation in toilet habits.

19. Need of Support in adherence to treatment including preparing medication, reviewing

medication consumpion.

20. Need of support in compliance with non pharmachological treatment including active and


21. Need of support or interventions in managing meals in case of eating disorder or

malnutrition

22. Need of support and assistance for effective communication.

23. Need of support and rehabilitation of cognitive abilities (memory, attention, orientation

etc.)

24. Need of support and management of behavior disorders associated with dementia.

25. Need of technical support with external devices: Oxygen, NIMV (non-invasive mechanical

ventilation), feed pumps, infusion pumps, home peritoneal dialysis, etc ...

The need of a COMPREHENSIVE CONSIDERATION of the person

26. Need to be self-determined and independent.

27. Need to a respectful treatment according to his/her dignity

28. Need for protection of user privacy and intimacy

29. Need to see defended and to be supported in his own interests

30. Need to feel a deep respect regarding values (including religious beliefs and spiritual

needs).

31. Need to be informed about your state of health and the available treatment and care

options


1.5 Let’s focus on the PROFESSIONAL COMPETENCIES required by homecare. What do you think are the COMPETENCIES required to perform

the activities you ACTUALLY carry out and to address the needs you ACTUALLY target? How do you master these competencies? How did you

acquire these competences?

Please select “required” in the list below for all of the competencies that you think are required.

Then, for each of the “required” competencies specify:

- The level you self-esteem you master the competence

- If you acquired the competence attending a school, a training course or an academic course

- If you acquired the competence by working practice


REQUIRED?


YOU MASTER THE

COMPETENCE

COMPETENCE ACQUIRED



ACADEMIC COURSE

COMPETENCE ACQUIRED

BY WORKING PRACTICE


MENU DROPDOWN

NOT

REQUIRED/REQUIRED

[DEFAULT NOT

REQUIRED]

MENU DROPDOWN

[NO ANSWER

Low Mastery

Average Mastery

High Mastery]

[DEFAULT NO ANSWER]

MENU DROPDOWN

NO/YES/NO ANSWER

[DEFAULT NO ANSWER]

MENU DROPDOWN

NO/YES/NO ANSWER

[DEFAULT NO ANSWER]






Basics in dietetic
















Cooking



Managing errands








Competences for caring with


dignity








Grief support




1.6.a. Are there other competencies that you think are required to perform the activities you

actually carry out and to address the needs you actually target in addition to those listed below?

1. Yes

2. No

1.6.b. If yes, please list them below: [conditioned item: if 1.6.a = yes]

1)______________________________

2)_______________________________

3)_________________________________

4)________________________________

5)__________________________________

SECTION 2 –TARGETED NEEDS AND COMPETENCES IN AN

IDEAL HOMECARE

In this section of the questionnaire we will focus on an IDEAL situation, asking you to identify

possible further older persons’ needs to address and possible further competencies necessary to

target them.

2.1.a. Do you think that there are some users’ needs that should be addressed by your activity AS

SPECIFIC PROFESSIONAL in addition to those selected above?

1. Yes

2. No

2.1.b If yes, which one of the following? [Please select all of the needs you currently don’t address

but you think you should address - more than one choice is possible] [conditioned item: if 2.1.a =

yes]

Need for BASIC PERSONAL attention

1. Need to be supported in hygiene including shower or bath or oral hygiene

2. Need of assistance for dressing up and undressing

3. Need of assistance for transfers and mobilization at home

4. Need for a proper maintenance of the house including cleaning and order washing, ironing

and organization of the clothes inside the home

5. Prevention of skin lesions through proper hygiene, postural changes and specific skin care.

6. Specific care of urinary and fecal incontinence.


7. Need of support and assistance in food management including preparation meals and

purchase of foods

8. Need of basic maintenance of household appliances and the ones of personal use,

including protection and security review tasks of housing (ventilation, gas, electricity ...).

9. Need of support and assistance to accomplish administrative procedures including those

relating with health.

10. Need of support for the management of technological devices for home health monitoring

11. Need of support in mobility out of home

Need for BIO-PSYCHO PHYSICAL HEALTH support.

12. Need of protection and promotion of the psychological and emotional welfare and

protection 13. Need of assistance to avoid situations of loneliness and isolation and facilitate family and


14. Need to be supported in the self-management of his/her physical health.

15. Need to be supported in the self-management of his/her mental health

Other needs in situations involving particularly PREVALENT DISEASES in aging.

16. Need to be supported and educated in proper positioning and postural changes to prevent

physical disorders

17. Need to feel safe and secure in his/her surroundings including suitability of the home to

prevent "static causes "of falls (assistance in removing barriers and adaptation of the

home).

18. Need of support and rehabilitation in toilet habits.

19. Need of Support in adherence to treatment including preparing medication, reviewing

medication consumpion.

20. Need of support in compliance with non pharmachological treatment including active and


21. Need of support or interventions in managing meals in case of eating disorder or

malnutrition

22. Need of support and assistance for effective communication.

23. Need of support and rehabilitation of cognitive abilities (memory, attention, orientation

etc.)

24. Need of support and management of behavior disorders associated with dementia.

25. Need of technical support with external devices: Oxygen, NIMV (non-invasive mechanical

ventilation), feed pumps, infusion pumps, home peritoneal dialysis, etc ...

The need of a COMPREHENSIVE CONSIDERATION of the person

26. Need to be self-determined and independent.


27. Need to a respectful treatment according to his/her dignity

28. Need for protection of user privacy and intimacy

29. Need to see defended and to be supported in his own interests

30. Need to feel a deep respect regarding values (including religious beliefs and spiritual

needs).

31. Need to be informed about your state of health and the available treatment and care

options


2.2 Which of the following competencies do you think are REQUIRED for addressing the ADDITIONAL NEEDS selected above? How do you

master these competencies? How did you acquire these competences? [conditioned item: if 2.1.a = yes]

Please select “required” in the list below for all of the competencies that you think are required for the additional needs

Then, for each of the “required” competencies specify:

- The level you self-esteem you master the competence

- If you acquired the competence attending a school, a training course or an academic course

- If you acquired the competence by working practice


REQUIRED?


YOU MASTER THE

COMPETENCE

COMPETENCE ACQUIRED



ACADEMIC COURSE

COMPETENCE ACQUIRED

BY WORKING PRACTICE


MENU DROPDOWN

NOT

REQUIRED/REQUIRED

[DEFAULT NOT

REQUIRED]

MENU DROPDOWN

[NO ANSWER

Low Mastery

Average Mastery

High Mastery]

[DEFAULT NO ANSWER]

MENU DROPDOWN

NO/YES/NO ANSWER

[DEFAULT NO ANSWER]

MENU DROPDOWN

NO/YES/NO ANSWER

[DEFAULT NO ANSWER]






Basics in dietetic













Procedures for personal


hygiene


Cooking



Managing errands

















Grief support



2.3.a. Are there other competencies that you think are required to address the additional needs?

1. Yes

2. No

2.3.b. If yes, please list them below: [conditioned item: if 2.3.a = yes]

1)______________________________

2)_______________________________

Deliverable 2.1


3)_________________________________

4)________________________________

5)__________________________________

SECTION 3 – YOUR OPINION ABOUT YOUR RELATIONSHIP WITH

THE USER

Please specify you opinion about each of the following sentences choosing a number in a scale

from 1=”I totally disagree” to 5=”I totally agree”

3.1 I feel I can help the customer to keep social and family relationships.

Totally disagree

Disagree Uncertain Agree Totally agreee

1 2 3 4 5

3.2 I feel I have the capacity to help the customer to solve his /her daily problems or to know where to find

support

Totally disagree


1 2 3 4 5

3.3 I feel my work respects the customer´s lifestyle and habits

Totally disagree


1 2 3 4 5

3.4I am aware/I’ve been properly informed about f his/her mental health status, beside to the general health

status

Totally disagree


1 2 3 4 5

3.5 I feel I have the capacity to pay attention to the customer´s problems and comments

Totally disagree


1 2 3 4 5


SECTION 4 – EVALUATION OF OLDER PERSONS’ NEEDS

4.1.a Do you normally participate in the definition of the older person’s needs?

[conditioned item: if 0.2 = 1 or 2 (no freelance)]

1. Yes

2. No

4.2.a Do you normally participate in the definition of a personalized homecare plan?

[conditioned item: if 0.2 = 1 or 2 (no freelance)]

1. Yes

2. No

4.1.b Do you formalize in a sheet, a chart or a report the initial evaluation of older person’s needs?

[conditioned item: if 0.2 = 3 or 4 (freelance or other)]

1. Yes

2. No

4.2.b Do you formalize in a sheet, a chart or a report a personalized homecare plan for the older

person?

[conditioned item: if 0.2 = 3 or 4 (freelance or other)]

1. Yes

2. No

4.3 Do you normally evaluate in itinere elderly needs in order to possibly refine the homecare plan

according to changing situations?

1. Yes

2. No

4.4.a Do you think do you have the proper competencies to evaluate older person’s needs and

build a personalized homecare plan ?: [conditioned item: if 4.1.a or 4.1.b = yes]

1. Yes

2. No

4.4.b. If no, please list the competencies you feel you lack?: [conditioned item: if 4.4.a = no]


1)______________________________

2)_______________________________

3)_________________________________

4)________________________________

5)__________________________________

4.5. While defining a homecare plan, do you set your intervention in a more general personalized

path for independent life and dignity?

1. Yes

2. No

4.6.a. Do you think do you have the proper competencies to set your intervention in a more

general personalized path for independent life and dignity? [conditioned item: if 4.5.a = yes]

1. Yes

2. No

4.6.b. If no, please list the competencies you feed you lack?: [conditioned item: if 4.6.a = no]

1)______________________________

2)_______________________________

3)_________________________________

4)________________________________

5)__________________________________

SECTION 5 - ROLE OF THE HOMECARE PROVIDER ORGANIZATION

IN THE DELIVERY OF THE SERVICE

[conditioned section: if 0.2 = 1 or 2 (no freelance)]

5.1.a Does your organization provide you with detailed operative guidelines?

1. Yes

2. No

5.1.b If yes, what is the level of your autonomy with respect to the guidelines? Please select a value

from 1=no autonomy to 5=complete autonomy


1 2 3 4 5

5.2 In which way do you report to your organization the activities daily carried out?

1. I provide no report

2. Only by speech

3. By weekly reports on a predefined format

4. By daily reports on a predefined format

5. By weekly written reports without predefined format

6. By daily written reports without predefined format

7. Other [specify________________________]

SECTION 6 – YOUR EDUCATIONAL and CAREER PATHWAY

6.1 Which is your educational qualification?

[close set of answers to be defined specifically for each country]

1.

6.2.a Do you have additional professional qualifications?

1. Yes

2. No

6.2.b. If yes, please specify [conditioned item: if 6.2.a = yes]

1)______________________________

2)_______________________________

3)_________________________________

6.3 Since how many years have you been working in older persons’ homecare?

1. Less than 1 year

2. From 1 to 5 years



5. More than 20 years

6.4 How many career advancements have you experienced working in homecare? [conditioned

section: if 0.2 = 1 or 2 (no freelance)]

1. None

2. One

3. Two


4. Three

5. More than three

6.5 Do the career advancements happened in the same provider organization or changing

employer? [conditioned item: if 6.4≠none]

1. same organization

2. changing employer

3. both

SECTION 7 – ATTITUDE TOWARD LONGLIFE LEARNING

7.1. How many longlife learning courses did your provider organization propose to you in the last 5

years?

[conditioned section: if 0.2 = 1 or 2 (no freelance)]

1. None

2. One

3. Two

4. Three

5. Four

6. Five

7. More than five

7.2 How many longlife learning courses did you attend in the last 5 years?

1. None

2. One

3. Two

4. Three

5. Four

6. Five

7. More than five

7.3 Do you think that longlife learning is important for your profession? Please specify the level

of importance in a scale from 1=no importance to 5=extreme importance

1 2 3 4 5

Deliverable 2.1


39 Annex 2: Structured interview to older adults

ERASMUS PLUS 2015


AGREEMENT No. 2015 – 3212 / 001 – 001


WP2 - Older Adults Interview

Supporting Tool

PIN participant

-

Interviewer

Interviewer signature

Agreement no. 2015 – 3212 / 001- 001


1 Interview Date

2 Birth Date

3 Caregiver present Yes □ No □ N/A □

4 Education Level

□ primary

□ secondary (first degree)

□

secondary (first degree)

□Bachelor

degree

□ Master degree

5 Gender Male □ Female □

6 Method of the interview

-by phone □ -personally □

-other (what?) ………………………………………….. …………………………………….……

7 Location of user living City

center□

City periphery

□

Big

village□

Small

village□

Country/mountain

□

SECTION 0

Dear MS/Mr….

Let’s start with few information about the homecare service that you experienced. Please refer to only one

service/experience.

0.1 Which kind of professional/professionals provided you with the service?

Don’t list possible answers to the user. Select one or more options according to user free speech

0.□ Nurse

1.□ Physiotherapist

2.□ Psychologist

3.□ Educator

4.□ Home care assistant/ home helper

5.□ Other [specify_______________________________________]

6.□ Practical Nurse [only for Finland]

7.□ Occupational Therapist [only for Italy]

8.□ Dietitian [only for Italy]

9.□ Speech therapist [only for Italy]

10.□ OSS – Social Health Operator [only for Italy]

11.□ Social Guardian [only for Italy]

12.□ Assistente Domiciliare tutelare [only for Italy]

NOTES:

Agreement no. 2015 – 3212 / 001- 001


SECTION 1

1.1 Now I will read a list of activities. For each one you should say to me if this activity has been

carried out or not.

1.□ evaluation of your needs

2.□ evaluation of your health condition

3.□ in-home health exams (e.g. taking blood sample)

4.□ personal assistance planning

5.□ companionship

6.□ support and assistance in social relationships

7.□ Home Environment assessment in terms of safety, hygiene, etc.

8.□ Assistance in the prescription and use of principals tools you use in home environment (crutches,

wheelchair, blood pressure measurement machine, etc.)

9.□ education in health management and lifestyle

10.□ personal hygiene (bathing, grooming, etc.)

11.□ house management and cooking

12.□ Support to daily activities (shopping, going to a medical appointment, etc.)

13.□ Illness prevention interventions

14.□ monitoring healthy lifestyle

15.□ pharmacological treatment and skin treatment

16.□ rehabilitation activities (walking, exercises, etc.)

17.□ positioning and supporting mobility

18.□ educational interventions for your relatives and friends

1.2 Do you want to point out other activities that the professional carried out at your own home

during the service?

1.□ Yes

2.□ No

1.3 Which ones?

Take note according to user free speech

1) _____________________________________________________________________

2) _____________________________________________________________________

3) _____________________________________________________________________

4) _____________________________________________________________________

5) _____________________________________________________________________

Agreement no. 2015 – 3212 / 001- 001


Let’s focus on the time spent by the practitioner at your home.

1.4 What is the average time ACTUALLY spent by professional at your home each time he/she

comes?

1.5 How many times on average do you receive the visit of the professional at your home in a

week?

1.6 How can you define the relation/interaction that you normally establish with the professional

that visit you at home? I’ll give you some options and you can choose more than one of them

1.□ deep

2.□ friendly

3.□ professional

4.□ detached

5.□ Other [specify____________________________________________________]

Read the question without listing the possible options. You have to check the proper option on the base of the

free speech of the user

1.□ Up to 15 minutes

2.□ From 15 to 30 minutes

3.□ From 30 min to 1 hour

4.□ From 1 to 2 hours



7.□ Other [specify_______________________________________]

Read the question without listing the possible options. You have to check the proper option on the base of the

free speech of the user

1.□ Less than once

2.□ Once

3.□ From 2 to 3 times



6.□ More than 7 times

Agreement no. 2015 – 3212 / 001- 001


SECTION 2

Let’s focus on your needs.

2.1 Can you tell me some needs of your own that the professional fulfilled providing the service?

2.2 Let’s see if discussing together we’ll be able to identify further needs that have been fulfilled.

What about

- Needs of support in daily activities (including hygiene, mobility, dressing, cleaning, food,

mobility in and out of home etc.) and managing home and own interests

Some of these needs have been fulfilled?

- technical help in managing medical tools or help with the assumption and management of

therapy;

- needs of support to maintain an healthy lifestyle and wellbeing

- needs for privacy, intimacy, independency and protection from mistreatments.

Some of these needs have been fulfilled?

2.3 Let’s finally focus on needs that you’d like to have satisfied but the professional doesn’t fulfilled.

Can you mention some of them?

In this section you should identify the user needs that are fulfilled by the service and needs that are not fulfilled

but they’d like to be fulfilled.

Using the same matrix of data (the one in the following page), you have to classify answers to 3 main questions, in

3 different columns in the matrix, identified by the number of the question.

As to the first question (2.1), you have to check in column 2.1 the needs you deem that are mentioned by the user

in a free speech.

As to the second question (2.2), you have to try to identify further fulfilled needs by suggesting macro-categories

of needs. If the user decide to add some needs to the ones listed in 2.1 you have to check them in column 2.2.

As to the third question (2.3), you have to check in column 2.3 the needs you deem that are mentioned by the

user in a free speech.

IF YOU ARE NOT ABLE TO CLASSIFY IMMEDIATELY THE ANSWER, USE THE SPACE BELOW TO TAKE NOTES


NEEDS MACRO CATEGORIES 2.1 2.2 2.3 LIST OF NEEDS

Need of support in daily activities (including hygiene, mobility, dressing, cleaning, food, mobility in and out of home etc.) and managing home and own interests

support in hygiene including shower, bath or oral hygiene

assistance for dressing up and undressing

help in toilet such as transferring to the toilet, cleaning self or uses bedpan or commode

assistance for transfers and mobilization at home for example from bed to chair or from chair to stand up

help in managing incontinence of bowel or bladder

support and assistance in feeding including preparation meals and gets food from plate in to mouth

support on shopping and purchases such as select the products (food or newspapers), giving the right amount of money and managing the rest

maintenance of the house including cleaning the floors, laundry, organization of the clothes inside the home etc.

support in mobility out of home including the use of public or private transportations

basic maintenance of household appliances and the ones of personal use, including protection and security review tasks of housing (ventilation, gas, electricity ...).

support and assistance to accomplish administrative procedures including to handle finances

Support in particular health conditions that require specialists such as skin lesions, technical help in managing medical tools, assumption and management of therapy.

prevention of skin lesions through proper hygiene and specific skin care.

support in proper positioning and postural changes to prevent physical and skin disorders

support or interventions in feeding due to in case of eating disorder and dysphagia

support and assistance for effective communication

Support in adherence to treatment including preparing medication, reviewing medication consumption

support and help in memory difficulties (reminding things to do), names, locations orientation when you are out of home

technical support with external devices: Oxygen, NIMV (non-invasive mechanical ventilation), feed pumps, infusion pumps, home peritoneal dialysis, etc

Need for support in prevention from any health risk (including home suitability) and maintenance of healthy lifestyle and wellbeing including physical health (such as physical exercises or walks) mental wellbeing, and social relationships.

support in compliance with not pharmacological treatment including active and health lifestyle such as prescribed diet, food intake control, physical exercises

safety and security in his/her surroundings including suitability of the home to prevent "static causes "of falls (assistance in removing barriers and adaptation of the home).

protection and promotion of the psychological and emotional welfare

assistance to avoid situations of loneliness and isolation and facilitate family and social relations or participation.

The need of a comprehensive and respectful consideration of myself, according to my dignity and values including privacy, intimacy, independency and protection from mistreatments.

need to be self-determined and independent

need to a respectful treatment according to his/her dignity

need for protection of user privacy and intimacy

need to see defended and to be supported in his own interests

need to feel a deep respect regarding values (including religious beliefs and spiritual needs)

need to be informed about your state of health and the available treatment and care options


2.4 Ok. Now I try to summarize and list both the needs you feel fulfilled and the needs that are not

fulfilled but you’d like them to be.

Can you say which needs (independently if they are fulfilled or not) have an high importance

and priority for you? For example, can you tell me 3 of them in order of importance, from the

most important to the less important one?

SECTION 3

3.1 Now please mention THREE abilities or characteristics that you consider should be fundamental for

a homecare professional to have.

3.2 Now please mention THREE aspects you consider have improved your quality of life since the

homecare professional assists you.

Read the answers you checked in the matrix above, trying to use a user-friendly language.

1- ______________________________________________________________________________________

2.- ______________________________________________________________________________________

3.- ____________________________________________________________________________________

POSSIBLE NOTES:

1- ______________________________________________________________________________________

2.- ______________________________________________________________________________________

3.- ____________________________________________________________________________________

POSSIBLE NOTES:

1- ______________________________________________________________________________________

2.- ______________________________________________________________________________________

3.- ____________________________________________________________________________________

POSSIBLE NOTES:

Agreement no. 2015 – 3212 / 001- 001


40 Annex 3: Finnish questionnaire targeting HHCPs: detailed

percentages of knowledges, skills and competences (KSC)

General competence in medical knowledge specifically related to the profession

1. KSC don’t needed 0,2 % 2. KSC needed 85,5 % 3. Satisfactory level of KSC 3,3 % 4. Good level of KSC 58,9 % 5. Excellent level of KSC 34,3 %

1. KSC developed during education 59,3 % 2. KSC developed worked based 60,5 %

General knowledge, skills and competences in anatomy, physiology and patology



General knowledge, skills and competences in personal and environmental hygiene


1. KSC developed during education 53,5 % 2. KSC deleloped worked based 65,6 %

General knowledge, skills and competence in home economics



General knowledge, skills and competences in nutrition/ dietetic

1. KSC don’t needed 6,1 % 2. KSC needed 78,6 % 3. Satisfactory level of KSC 3,7 %

Agreement no. 2015 – 3212 / 001- 001


4. Good level of KSC 51,5 % 5. Excellent level of KSC 39,6 %


General knowledge, skills and competences in healthy lifestyle of older people



General knowledge, skills and competences in psychology elements 6. KSC don’t needed 23,3 % 7. KSC needed 60,8 % 8. Satisfactory level of KSC 22,4 % 9. Good level of KSC 50,1 % 10. Excellent level of KSC 16,8 %


General knowledge, skills and competences in safety at home and prevention of accidents



General knowledge, skills and competences in social-health services organizations and networks



General knowledge, skills and competences about the main aids and devices for older and disabled people



Agreement no. 2015 – 3212 / 001- 001


General knowledge, skills and competences in basic on the main characteristics of peoples with different levels of autonomy

1. KSC don’t needed 40,9 % 2. KSC needed 44,7 % 3. Satisfactory level of KSC 24 % 4. Good level of KSC 50,6 % 5. Excellent level of KSC 8,8 %


General knowledge, skills and competences in basics in law and human rights frameworks



General knowledge, skills and competences in basic procedures in medical assistance (eg. make injection, provide drugs, change medications, etc.)



General knowledge, skills and competences in other specific basic medical procedures related to my profession



Knowledge, skills and competences in procedures for providing medical therapies



Knowledge, skills and competences in procedures for providing physical therapies

1. KSC don’t needed 45,8 % 2. KSC needed 41,1 %

Agreement no. 2015 – 3212 / 001- 001


3. Satisfactory level of KSC 29,2 % 4. Good level of KSC 44,4 % 5. Excellent level of KSC 6,5 %


Knowledge, skills and competences in procedures for environmental hygiene



Knowledge, skills and competences in procedures for personal hygiene



Knowledge, skills and competences for procedures for customer moving



General knowledge, skills and competences in cooking

1. KSC don’t needed 48,4 % 2. KSC needed 39,0 € 3. Satisfactory level of KSC 4,2 % 4. Good level of KSC 35,7 % 5. Excellent level of KSC 41,1 %


40.1.1 General knowledge, skills and competences for procedures for defining an eating plan (nutrition)


1. KSC developed during education 52,9 %

Agreement no. 2015 – 3212 / 001- 001


2. KSC developed worked based 50,6 % 40.1.2 General knowledge, skills and competences for procedures for monitoring healthy lifestyles

1.KSC don’t needed 17,1 % 2. KSC needed 69,0 % 3. Satisfactory level of KSC 5,9 % 4. Good level of KSC 54,9 % 5. Excellent level of KSC 29,8 %

1.KSC developed during education 50,0 % 2.KSC developed worked based 59,4 %

General knowledge, skills and competences for usage of reporting and monitoring tools



General knowledge, skills and competences in methods for procedures for fostering customers going out of home



General knowledge, skills and competences for methods of fostering customers social and familiar relations



General knowledge, skills and competences in using ICT for social participation



General knowledge, skills and competences of ICT using for health status monitoring

Agreement no. 2015 – 3212 / 001- 001




General knowledge, skills and competences in providing the customer with contextualized and personalized information about the network of services he/she can rely on

1. KSC don’t needed 11,5 % 2. KSC needed 74,8 % 3. Satisfactory level of KSC 20,2 % 4. Good level of KSC 56 % 5. Excellent level of KSC 15,8 %


General knowledge, skills and competences in basic procedures in medical assistance (eg. make injection, provide drugs, change medications, etc.)



General knowledge, skills and competences for caring with dignity



General knowledge, skills and competences for managing conflicts



General knowledge, skills and competences for cooperation and networking in multi-disciplinary team

1. KSC don’t needed 7,1 % 2. KSC needed 79,5 % 3. Satisfactory level of KSC 6,1 %

Agreement no. 2015 – 3212 / 001- 001


4. Good level of KSC 56,8 % 5. Excellent level of KSC 30,4 %


General knowledge, skills and competences in networking and coordination



General knowledge, skills and competences in team working by mobile advices

1. KSC don’t needed 19,4 % 2. KSC needed 69,0 % 3. Satisfactory level of KSC 17,5 % 4. Good level of KSC 44,1 % 5. Excellent level of KSC 22,0 €


General knowledge, skills and competences for evaluating customer needs and adapting the service



General knowledge, skills and competences for evaluating customer mental health status



General knowledge, skills and competences in empowering the customer



General knowledge, skills and competences in grief process

Agreement no. 2015 – 3212 / 001- 001



1. KSC developed during e ducation 36,2 % 2. KSC developed worked based 66,8 %

General knowledge, skills and competences in terminal care



General knowledge, skills and competences for supporting the customer in building up an independent living path

