the flemish model, a multiplicity of home care organizations sarah willockx
TRANSCRIPT
The Flemish model, a multiplicity of
Home Care organizations
Sarah Willockx
Belgium: Politics and societystructure of state Federal stateFederal state
Competent for specific matters such as Competent for specific matters such as ‘social security’‘social security’
3 communities3 communities: Flemish, French-speaking, : Flemish, French-speaking, German-speaking communityGerman-speaking community Competent for personal matters such as Competent for personal matters such as
education and welfareeducation and welfare
Flemish or Dutch-
speaking community
French-speaking
community
German-speaking
community
Communities
The social security system
Totally elaborated system: Totally elaborated system: Elderly pensionsElderly pensions Unemployment benefitsUnemployment benefits Family allowancesFamily allowances Sickness and disability insuranceSickness and disability insurance
2 pillars 2 pillars insurance principle insurance principle solidarity principlesolidarity principle
Control and organisation by federal stateControl and organisation by federal state
per age group of 5 years and per 1.000 inhabitantsSource: www.statbel.fgov.be
Demographic context
Door-to-door care for costumerDoor-to-door care for costumer Support proximity aidSupport proximity aid Promote independencyPromote independency Non-commercial point of viewNon-commercial point of view No exclusion based on risk, financial situation, No exclusion based on risk, financial situation,
race or convictionrace or conviction
Home Care services in BelgiumPurpose
Nursing tasksNursing tasks
Help with: Help with: - everyday personal hygiene- everyday personal hygiene- medical care- medical care
Specialized tasks by specialized nursesSpecialized tasks by specialized nurses
Federal home nursing
Job contents
Personal hygiene Personal hygiene Domestic helpDomestic help Cleaning helpCleaning help General psychosocial and pedagogical supportGeneral psychosocial and pedagogical support
Job contents
Non-medical home services
Growing demand for logistic help and Growing demand for logistic help and additional home helpadditional home help
Cleaning help, odd jobs and sitting services + Cleaning help, odd jobs and sitting services + general psychosocial and pedagogical supportgeneral psychosocial and pedagogical support
Wallonia: elaboration in progressWallonia: elaboration in progress Flanders: own rules already appliedFlanders: own rules already applied
Job contents
Logistic services
Cleaning, ironing and cooking at home of Cleaning, ironing and cooking at home of costumercostumer
Also ironing, transport or shopping servicesAlso ironing, transport or shopping services Employment measureEmployment measure Fight illegal workFight illegal work Support families with two partners out workingSupport families with two partners out working Accessible for everyone: with or without need of Accessible for everyone: with or without need of
carecare
Job contents
Service vouchers
Medical care: doctor’s prescriptionMedical care: doctor’s prescription
Personal hygiene: No prescription GP Personal hygiene: No prescription GP
Katz-scaleKatz-scale
Conditions & accessibility
Home nursing
No formal referenceNo formal reference
Contact by: costumers, proximity caretakers or Contact by: costumers, proximity caretakers or 3rd persons (GP, social service hospital) 3rd persons (GP, social service hospital)
Social examination by social workerSocial examination by social worker
Conditions & accessibility
Non-medical home care services
No fixed rulesNo fixed rules
Often same procedure as non-medical home Often same procedure as non-medical home carecare
Conditions & accessibility
Logistic services
Target group: able-bodied healthy peopleTarget group: able-bodied healthy people
Apply at certified organizationApply at certified organization
Exception in Walloon part: also for Exception in Walloon part: also for
non-medical home care servicesnon-medical home care services
Service vouchers
Conditions & accessibility
Qualified nurses: bachelor, master or Qualified nurses: bachelor, master or registeredregistered
Reference nurseReference nurse Wage earning or self-employedWage earning or self-employed
Organization & caregivers
Home nursing
Caregiver: certificate regular daytime classes Caregiver: certificate regular daytime classes or adult educationor adult education
Wage earners for a certified home care serviceWage earners for a certified home care service
Organization & caregivers
Non-medical home care services
Flanders: no specific certificateFlanders: no specific certificate
Wallonia: sitting services require certificate of Wallonia: sitting services require certificate of professional caregiverprofessional caregiver
Organization & caregivers
Logistic services
No specific certificateNo specific certificate
Employed by a certified firmEmployed by a certified firm
Certified firms: commercial or non-commercialCertified firms: commercial or non-commercial
Steady jobSteady job
Service vouchers
Organization & caregivers
Federal matter< social securityFederal matter< social securitySubsidies rating per nursing actSubsidies rating per nursing act
Lump sum: based on degree of need of careLump sum: based on degree of need of care
Third party system: user pays nothingThird party system: user pays nothing Share of beneficiary can be chargedShare of beneficiary can be charged
Legal & financial frameworkHome nursing
Community matterCommunity matter Public and private servicesPublic and private services
FlandersFlanders: quota of subsidized hours based on programming : quota of subsidized hours based on programming figuresfigures
WalloniaWallonia: subsidies per geographic zone & per service: subsidies per geographic zone & per service
WalloniaWallonia: limited 200 hours per user / trimester: limited 200 hours per user / trimester FlandersFlanders: no limitation: no limitation
Legal & financial frameworkNon-medical home care services
User contribution per hour depending on income User contribution per hour depending on income and family situation:and family situation:
FlandersFlanders: 0.5 € : 0.5 € cost price cost price Gravity of need = reduction Gravity of need = reduction
possible (possible (average 3.5 €) average 3.5 €)
WalloniaWallonia:0.9 € :0.9 € 8 € 8 €(average 2.60 €)(average 2.60 €)
Legal & financial frameworkNon-medical home care services
Community matterCommunity matter
How?How?
FlandersFlanders: envelop financing on annual basis per : envelop financing on annual basis per full time equivalentfull time equivalent
WalloniaWallonia: no specific financial framework : no specific financial framework
user pays small contribution based on income user pays small contribution based on income and family situationand family situation
Legal & financial frameworkLogistic services
Federal matterFederal matter
How?How? fixed wagefixed wage User buys voucher of 7.50€/hourUser buys voucher of 7.50€/hour Fiscal advantage of 30% (2.25€/hour)Fiscal advantage of 30% (2.25€/hour) Voucher is worth 20.80€ for the employerVoucher is worth 20.80€ for the employer Financed by federal governmentFinanced by federal government
Legal & financial frameworkService vouchers
Types of services not unrelatedTypes of services not unrelated
Disciplinary and multidisciplinary considerationDisciplinary and multidisciplinary consideration
Structured formal considerationStructured formal consideration
Multidisciplinary collaboration & consultative bodies
Ageing and declining populationAgeing and declining population
Solidarity principle under pressure?Solidarity principle under pressure?
Market developmentsMarket developments
Job demarcation and competencesJob demarcation and competences
Challenges