The Aged Care System in Denmark

Dr A Andrew Fleming

Southern Cross Care (NSW & ACT) Inc

University of Western Sydney

Denmark – Some Facts

• Population of 5.3 million

• 13% over 65 years

• Demographic ageing– By 2025 over 65s will grow by one third

• High labour force participation rates– 76.3% persons 16 to 66 years working– 79.1% of women work

Denmark – Some Facts

• In 2004 population 67+ = 700,00

• 500, 000 able to manage at home

• 175,000 receive public home help

• 23,000 live in nursing ‘homes’

Copenhagen – Some Facts

• Population of 500,000

• 12.1% over 65 years

• Home and Care Service– 95,000 visits in 17,000 homes

• Housing for older people– 4700 purpose-built ‘elder homes’– 4900 nursing ‘home’ places

Social Policy in Denmark

• Welfare State

• ‘Cradle to the grave’

• Universal benefits and services– Financed through general taxes– Centralised pension– Decentralised system of care services

• Challenges of demographic ageing

Welfare State Welfare Society

• Legislate and allocate funds

• OS – umbrella organisation promoting the welfare of older Danes:

- influence policy on older persons

- educate the community, e.g. dementia

- development of personal skills and knowledge

Welfare State Welfare Society

• Develop voluntary social work

- NB volunteerism is relatively new for adult Danes

- target lonely and isolated older people

- ‘fit’ elderly helping ‘frail’ elderly, e.g.‘visiting friends’ program

• Using technology such as the internet and ‘Webcasts’

Local Government Responsibilities

• 14 counties– Hospitals

– Medical care outside hospitals

– Services for disabled and abusers

• 275 municipalities– Care for dependent older persons and day care facilities

– Social security schemes, e.g. old age pension, sickness benefits, child allowance

Intrinsic Value of Older People

• Local senior citizens’ council (4 years)

• Complaints Board

• Platform for communication between older people and local council

• All matters relevant to older people must be referred, e.g. reports from quality visits to nursing homes

Community & Residential Care

• Well developed integration and interdependence

• Linkages provide for ‘seamless’ transitions

• Single point of entry

• Less choice for older Danes but this is changing

Community Care Services

• Copenhagen (67+ = 53, 930)

• Home nursing and home help – 16,800 clients

• 95,000 visits per week

• Elderly homes 81 per 1000

• Nursing homes 114 per 1000

Community Care Example

• Mrs W – 76 years, widow, 4 children, knee and back problems

• Ageing in place – up to 40 hours of home help

• Choice of supplier

• Home help starts immediately

• Community nursing generally through GP

Community Care Example

• Day Care Centre – 6 month contract• Physical training provided free• Subsidised dental treatment, transport and

food• Nursing ‘homes’ have some rehab ‘beds’

– Temporary rehab – home modifications

• Nursing homes – 24 hour care required• Persons given choice of nursing home

Health promotion

• Preventive house calls

• Danes 75+ offered a house call twice a year

• Aims:– Monitor health and well-being– Advice and support regarding resources and

services– Maintain function and quality of life

Fall Prevention In Copenhagen

• ‘Healthy city’ project from 1994 – 2003

• Health targets of:

- legal right to prevention

- increase average human life

- decrease social inequalities

- improve health and quality of life

- include general health in politics of local authority

Fall Prevention In Copenhagen

• Provide hip protectors free of charge

• Three pairs of ‘Safehip’ protectors distributed after:

- professional assessment

- a successful one week trial which includes a diary of pros and cons

- ‘Safehip’ to be worn a minimum of 8 hours/day

Fall Prevention In Copenhagen

• Outcomes:

- acceptance rate is approximately 33%

- 35% reduction in hospital discharges

- 19% reduction in incidence per 100,000 65+

- significant reduction in health spending

- NB hip protectors a supplement NOT a replacement

Housing for Older People

• Majority live in ordinary housing

• Only 4 – 5% in purpose-built or nursing home accommodation

• Need is the primary determinant of service

• Services delivered in:– Own home, ‘elder’ home or nursing ‘home’

• ‘Elder home’– Independent living complex with adaptive

housing

• Nursing ‘home’– ‘Apartments’ with one (50 sqm) or two rooms

(65 sqm) with a kitchenette and ensuite bathroom

– Communal areas, gymnasium, open café, day centre

Housing for Older People

Residents in Nursing Homes

• Free nursing services

• Purchase hotel services, e.g. domestic, food package

• Open café and day centre where people from general community attend for meals and/or services

• Gymnasium for residents and staff

Funding and Resources

• Frail older people equivalent of 0.95 per staff member per day

• Persons with dementia is 1.66• Activity centres is 0.433• Full-time physiotherapy staff

– 88 bed RCF has 50 hours of physiotherapy over 7 days

– Resident participation rate of 60%

Quality Assurance

• All municipalities must issue quality standards

• Monitor at least annually:– Nursing homes can expect 3 visits, 1 of which

is short notice

• Currently developing national standards– Exploring models as per Canada and Australia

Lessons for Us

• Well-established focus and resourcing of wellness and health promotion

• Intrinsic value of older people

• Integration of community and residential care – ease of navigation for consumers

• Increased funding of persons with dementia

• Flexible and adaptive housing at all levels

Lessons From Us

• Choice of providers for older Australians

• Dementia care and services

• Australian Aged Care Standards