Who Cares?Care coordination and cooperationto enhance quality in elderly care

in the European Union

Prof. Dr. Bernd Marin

Conference on Healthy and Dignified AgeingSwedish Presidency of the EU

15-16 September 2009

Long-term care in the EU today Long-term care: a late-comer in social protection systems Diversity and common trends in the EU Key policy challenges and good practices:

Better integration between health and long-term care Improved access to care for dependent old-age people Choice in publicly provided services Long-term care workforce policies Alzheimer diseases and other dementia Quality of services, quality assessment/control/assurance Instant JIT responsiveness, timeliness, delivery when needed Ageing in place and grace: dignity, respect, TLC

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Long-term care: a late-comer

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“Young” subject Arguably the social policy area where EU Member

Countries differ the most First steps as a differentiated policy field Common challenges interest in good practices Key issues for developing long-term care in the EU:

Enhanced coordination/integration of health and social care; User-oriented approach.

How many receive care in institutions?

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6.5%

Institutional care covers only a small percentage of older people

Share of older people receiving care in institutions (most recent date)

Source: Huber et al. (2009 forthcoming) Own calculations based on OECD, NOSOSCO , WHO, Eurostat and national sources.

Home is where you’re cared for

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Different approaches to care

Share of older people receiving long-term care services at home (most recent date)

Source: Huber et al. (2009 forthcoming) Own calculations based on OECD, NOSOSCO , WHO, Eurostat and national sources.

Providing more people with care

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Publicly provided care at home:the key for wider access to care

Share of older people receiving care at home and in as institutional setting (most recent date)

Source: Own calculations based on OECD, NOSOSCO , WHO, Eurostat and national sources.

Differences in informal care giving

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Percentage of the population aged 15+ providing informal care to a co-resident relative aged 60+ (1999)

Source: Huber et al. (2009, forthcoming) Own calculations based on Walker (1999).

Intimacy at a distance

Labour of love

Overburdened carers

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Lack of care services…

Providing care to co-residents…

… explaining carers’ burden?

EUROBAROMETER (2007) In your opinion, do dependent older people rely too much on their relatives?

Source: EUROBAROMETER (2007)

Mid-life challenges

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Providing care for older family members by country and age group

Source: OECD (2005), EUROFAMCARE national reports.

Reconciling work and care

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On an individual level:remains difficult

On a policy level:can the Lisbon Strategy and support to carers co-exist?

Employment status of main carers by country and domain

Source: National sources, EUROFAMCARE national reports, Lamura et al. (2006).

How much and where are we spending?

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Public resources: A diverse picture Modest amounts dedicated to care: EU15 spends 7.6% on health and 9.1% on old-age pensions alone

Paradox:most people cared for at home...... most public resources devoted to institutional care

Source: Huber et al. (2009, forthcoming) Own calculations based on OECD, NOSOSCO , Eurostat and national sources.

Public expenditure on long-term care and its distribution between home and institutional care (most recent date)

Making sense of differences in expenditure

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Different private public mixes in expenditure

Differences in quality

Relation between expenditure on old-age institutional care and share of older people benefiting from it, 2007

Source: Huber et al. (2009 forthcoming) Own calculations based on OECD, NOSOSCO, Eurostat and national sources.

How deep is the beneficiaries’ pocket?

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Paying for institutional care (EU level):

51.2% of public resources devoted to 3.3% of 65+...... yet, heavy private contributions still required.

User’s fee for institutional care, in percentage of the APW net wage (2007*)

Source: Huber et al. (2009 forthcoming) Own calculations based on national sources.

Trade-offs in benefit generosity

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Higher but targeted amounts

“Generous”?

Smaller portions of the pie

Amounts of attendance allowances in percentage of net wage of APW and its beneficiaries (2007 or most recent date)

Source: Huber et al. (2009, forthcoming).

The challenge of coordination and integration

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Health Care Systemdifferentiated, professionalised,

hierarchical, funded, rights-based Social Care System

local, less professionalised, badly funded, discretional

HospitalGener

al Practitioner

Nursing

Home

Care

Short term Care

Home Help

OtherServices,Housing,

etc.

Residential Care

Day Care

Overcoming barriers

An example of good practice

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Hospital

General Practition

er

NursingHome Care

Short term Care

Home Help

OtherServices,

Housing, etc.

Residential Care

Day Care

Skævinge (Denmark): The Health Centre ‘Bauneparken

How: Person-centred Single point of contact Case management Self-care and prevention

Outcomes: No waiting time Room for specialized services Reduced hospital stays Below average use of resources

24-hour integrated health and social care

Accessing mainstream health

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Dependent older people facing barriers in access

Major improvements should be possible in rehabilitation and mental health

Specialised research in health care for older people needed

MobilityGaps in geriatrician’s

training

Agediscrimination Poverty

Lowexpectations

Regulations

Having a choice on care

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Pathways to increased consumer choice: Empowering people with a

budget Opening the care market

to private providers

Challenges: Limits in using informal

carers Ensuring “market

thickness” Concentration of

providers

What have we learned from care markets?

Long-term care workforce

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Long-term care workers are crucial for quality Care services as a “job machine”However: Concerns remain over labour shortages Informal markets of care Can immigration fill the gap?Need for: Increased skills Better working and paying conditions

Alzheimer and other dementia

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Why Alzheimer and other dementia matter?

Improved dementia assessment and care…

… but tailored training of carers and improved early detection is still needed

Prevalence of dementia in Europe, by age-groups (2005)

Source: Alzheimer Europe (2006) based on Ferri et al. (2005).

Privacy in care home

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Where dignity of care and quality of living come together

Percentage of people living in rooms (institutional care) by number of beds per room

Percentage of people living in rooms (institutional care), by number of beds per room

Source: National sources and OECD (2005)

Future ageing in the older age groups

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Current and projected share of the population aged 80+, 2006 and 2050 (selected countries)

Huber et al. (2009) based on Eurostat EUROPOP2008.

Ageing and public expenditure in long-term care

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Ageing and public expenditure on long-term care, 2007

Source: Huber et al. (2009, forthcoming) Own calculations based on OECD, NOSOSCO , Eurostat and national sources.

Trade-offs in benefit generosity

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Amounts of care allowances in percentage of net wage of APW and its beneficiaries (2007 or most recent date)

Source: Huber et al. (2009, forthcoming).