Elder Care in EuropeAn overview of

its history and current trendsMarch 23rd 2011

Социальные услуги ХХI века: пожилых людейСанкт-Петербург

Freek Lapré (chair EAHSA)

WWW.EAHSA.EU• The European Association of Homes and Services for

the Ageing (EAHSA) is affiliated with the International Association of Homes and Services for the Ageing

• We have more than 2000 providers in our membership in 15 different European countries from all different industries related to elder care

• Based in Brussels• Europe = Greater Europe (> EU)

5 principles of EAHSA• Preserving dignity• Nurturing spirits in life• Comforting in partnership• Encouraging diversity • With a carefree approach

EAHSA NetworkMost relevant contacts:• IAHSA Washington DC (www.iahsa.net)• European Commission Brussels• European Centre for Social Welfare Policy and Research

(affiliated with UN) (www.euro.centre.org)• AGE Platform Europe (www.age-platform.org)• European Housing Forum (www.europeanhousingforum.org)• European Health Management Association (www.ehma.org)• Eden Europe (www.eden-europe.net)• European chapters of the International Society of

Gerontechnology (www.gerontechnology.info)

Why becoming a member ?

Part of European and International Network (EAHSA membership includes IAHSA membership):- Self learning: bi-annual conferences- Exchange of best practices and innovations- Reflection on your own development- Management exchange programmes- Exchange of quality frameworks: IAHSA Quality

Movement, Progress indicators

Snapshot of last EAHSA conference in Stockholm Sweden (2010)

EAHSA strategy towards Eastern Europe

• To broaden its geographic base and membership, EAHSA has initiated an EAHSA Eastern European Strategy (EES), within its vision of a broader European community

• Key components:– Establish a “network of stakeholders” in Eastern European

countries– Develop an EAHSA sponsored EES Forum to share information,

identify common issues, difficulties, etc. – Identify ways in which EAHSA could work with organisations,

NGOs, , etc. to facilitate progress– Locate sponsors for the Forum (and Strategy)

SICUAP, the Silver Time Foundation and EAHSA

• We congratulate our colleagues in Russia and welcome you in the EAHSA and IAHSA family

• We will build friendships between colleagues with a common aim: improve the quality of life of those who we serve

• We hope to learn from you and vice versa

History of elder care in Europe

• Started with family • Churches and other charities supported this

especially when there was no family• Communities took over• Governments came in:

– Local– National (moving back to local)

• Social care or health care

Supply of elder care in Europe: an overview

• Different countries, different systems: welfare, social care, health care

• Northern European countries: high degree of institutionalization

• Southern and Eastern Europe: family care, but growing demand for professional and institutional care

• Growing importance of home care

Home care vs. institutional care

But:

USA: mostly private funded

Finance of LTC

• Mostly tax based systems • Cost-sharing differs between countries:

– Cost sharing in institutional care– Cost sharing in home care differs: DNK home care

is free• Low private funding:

– Coverage by public insurance– High rate of informal care

Focus on:

• The United Kingdom• Romania• Italy• The Netherlands

United Kingdom

• Long term care is part of social care• Municipalities contract LTC-organisations• Since 1990: shift from institutional care to domiciliary

care • Non- and for-profit organizations• PM David Cameron wants increase home care to

shorten length of stay in hospitals• But there is a Chinese wall between social care and

NHS

Romania• Long waiting lists for residential care• Day care centres, but no respite care• Home care:

– Financed by the National Health Insurance Company– Limits until 56 days a year

• Personal assistance (paid volunteers): – provided by municipalities for so-called grade one

handicap that is entitled by a commission– Client or family needs to find someone who wants to be

a personal assistant

Italy• From 70’s until ’92 no clear concept about a

comprehensive LTC, regional differences• Still emphasis on family support, but family

support is decreasing• Therefore strong increase of demand for

professional and institutional care• Supply is insufficient• 1992: National Plan for the elderly

Netherlands• More then a century tradition of LTC starting from

charity• In 70’s financed by government as part of health care• Highly institutionalized and medicalized• Large organisations• Shift towards social care controlled by municipalities• Complex system of financial resources

(WMO (municipality), AWBZ (public insurance), Health Insurance (private insurance))

Future challenges LTC in Europe

• Labour: keep the sector attractive for professionals

• New (or old ?) concepts: de-institutionalisation, integration of informal care

• Building appropriate housing for the elderly• Financial sustainability

Ratio LTC staff per recipient >65 in facilities in 2007

OECD, 2009

Financial Sustainability of Long Term Care

% of GDP 2005 Projected % of GDP in 2050

Increase in %

United Kingdom 1.1 % 2.1 - 3.0 % 191 – 273 %

Italy 0.6 % 2.8 - 3.5 % 467 – 583 %

Germany 1.0 % 2.2 - 2.9 % 220 – 290 %

Netherlands 1.7 % 2.9 – 3.7 % 171 – 218 %

Japan 0.9 % 2.4 – 3.1 % 267 – 344 %

USA 0.9 % 1.8 – 2.7 % 200 – 300 %

OECD, 2010

Financial pressureForecast debt-to-GDP and general government financial balances, 2011

Source: OECD (2010b).

0 50 100 150 200 250

-12

-10

-8

-6

-4

-2

0

2

-4.18

-2.13

-7.13

-2.74

-5.01

-8.34

-5.62

-1.72

Gross government debt in percentage of GDP, 2011

Gen

eral

gov

ernm

ent b

alan

ce in

per

cent

age

of G

DP,

201

1

Current trends in elder care: governments

So the challenge for governments: an ageing society and less budget.• Moving from health care to social care• Restoring connection between social care and

health care• Public/private collaboration• More individual responsibility: informal care

and cost-sharing

Current trends in elder care: providers

The challenge: less budget and less staff• From large scale institutions to small scale facilities

integrated in neighbourhoods• Shift from quality of care to quality of life: more

emphasis on sustainable housing and extending range of services at home

• Application of technology: – As part of service supply: telehealth and telemonitoring– To increase efficiency: electronic records of clients

Some examples

Sustainable housing

Adapted housing

De Godtschalckwijk20 dwellings

19 singles (8 men en 11 women) 1 couplemedian age -70 years : 52 yearsmedian age +70 years: 79 years

32 dwellings

24 singles (18 women en 6 men) 8 couplesmedian age: 80 years

Nursing homes as habitats

Telehealth/telemonitoring

• Virtual desk• Monitoring system• Tele measuring of bodyfunctions

Examples are currently implementedin the Netherlands

Virtual desk

Courtesy NjbosGroep

Monitoring systems

Courtesy NjbosGroep

Telemeasuring bodyfunctions

Courtesy VitelNet

Innovative:• Plug and play device• Easily integrated in existing

callcenters of care service organizations

Hope to see you all at our 2012 conference at:

27-28 september 2012

MALTA

Thank you !

With regards to:• Dr. Francesca Colombo, OECD• Ricardo Rodrigues, ECV• Jean-Christophe Vanderhaegen, CBFB• Alzheimer Europe