Long-Term Care in Austria Home Care Europe Conference June 3 rd – 5 th 2009, Vienna Mag. Kurt...

Long-Term Care in Austria

Home Care Europe Conference

June 3rd – 5th 2009, Vienna

Mag. Kurt Schalek

Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 2


Framework of LTC Austria is a federal state

• Competencies are split between federal and nine provincial governments

• Federal activities are consistent in all provinces

• Provincial activities differ between nine provinces

Separation of health care and social system• LTC is primarily subject of the social care system

• Health care is involved in LTC when people are sick

• Difficulties in offering integrated services

LTC in Austria is a complex system• Many players in the field

• Differences for beneficiaries dependent on the province

• Complex political processes within this system



Benefits and Services

Cash benefits• Long-Term Care benefit

• Social assistance

Non-cash benefits, services• Services (e.g. home care, nursing homes, counselling)

• Facilities (e.g. walking frames, support of age-appropriate adaption of houses and flats, nursing beds)


Players in the LTC-System

Federal Ministry Federal Ministry of Social Affairsof Social Affairs

LTC benefit (7 levels), social security for uninsured informal carers, financial support for investments

and holidays for the major informal carer

Health Care Health Care InsuranceInsurance

Medical home care (nurses) if hospital care is substituted, assistive technology (e.g. walking frames)

Authorities of Authorities of ProvincesProvinces

LTC benefit on provincial level, all kinds of services in LTC, social assistance for residents in nursing homes and clients of home care

MunicipalitiesMunicipalities Services in LTC, social assistance for residents in nursing homes, other financial support, assisted living facilities

Individual/FamiliesIndividual/Families co-payments/deductibles, private investments in assistive technology, services etc., informal care by family carers (75-80% informal arrangements)


Sources of finance in LTC

Federal Ministry Federal Ministry of Social Affairsof Social Affairs

Cash-benefits financed by taxes

Health Care Health Care InsuranceInsurance

Financed by wage-dependent insurance premiums and tax-financed deficit coverage

Authorities of Authorities of ProvincesProvinces

Services and benefits financed by taxes and co-payments

MunicipalitiesMunicipalities Services and benefits financed by taxes and co-payments

Individual/FamiliesIndividual/Families Financed by income and/or private capital, non-paid services by informal carers


Long-term care benefit financial support for people in need

Purpose of LTC-benefit (§1 BPGG): • Overall financial contribution to costs related to the need for care/nursing

• Furthering opportunities for a self-determined living according to individual requirements

Beneficiaries are classified in 7 levels• From level 1 (least) to level 7 (highest)

Preconditions for entitlement• Living in Austria (under specific circumstances also in EWR-Countries)

• Need for care/nursing is expected to last longer than 6 months

• Application for LTC-benefit or for reclassification by (potential) beneficiary

• Medical examination for assessing need for care according to law

• Notification by the responsible authority


Long-term care benefit 7 levels of need for care

Preconditions Level € per month

Need for care/nursing more than 50 hours per month 1 154,20 Euro




Need for care/nursing more than 180 hours per month AND • Extraordinary need has to be covered

5 902,30 Euro

Need for care/nursing more than 180 hours per month AND• Care is needed during whole day (day and night) on a regular

basis and time of need is not predictable OR • Continuous presence of a caring person is necessary because

the concerned person is likely to endanger her-/himself or other people.

6 1.242,- Euro

Need for care/nursing more than 180 hours per month AND• Lack of the ability to move all four extremities intentionally in

order to fulfil functional tasks OR• Existance of any comparable condition

7 1.655,80 Euro


Long-term care benefit

How does the classification work? Need for care is expressed in time value for tasks

• e.g. washing an incontinent person: 4 x 10 min per day

3 ways how time for tasks can be valued• guide values: can be fixed individually by assessing experts• minimum values: exceeding has to be justified• fixed extra values: can be added for specific groups of clients (e.g.

demented people, disabled children)

Law restricts assessment to body-related & functional tasks• ADL: dressing, washing, mobility, eating and drinking (including artificial

feeding), elimination, intake of medicine, anus-praeter-care, care of canula, tubes, catheter, klysma

• I-ADL: purchase of food and medicine, heating, washing laundry• Disregarded aspects: communication, relation-building, surveillance when

time value less than 180 h/month, psychological aspects (e.g. fear), systemic aspects of care (e.g. care-related conflicts with informal carers)


Long-term care benefit

Problematic aspects Politicians regard results of LTC-benefit assessments

increasingly as indicator for need of care. But:

Assessment doesn’t give a full description of need for care• It is designed for distribution of an overall financial contribution only• Time values are designed to fit administrative processes but does not

reflect real values• Need for care must be justified by medical expertise instead of nursing

diagnoses that are more significant• Assessment doesn’t encompass all dimensions of care (ability for self-

care/resources, context factors and goals)• Lack of a standardised assessment tool • Assessment tools are not scientifically evaluated• Assessment focuses on a single moment only, not on a period of time

Access of beneficiaries to other benefits or support programs could be limited by inadequate assessment


Long-term care benefit Structure of beneficiaries 2007

Level of LTC-

benefit

Beneficiaries federal

level%

Beneficiaries

Prov.’l level% Total %

1 76.444 21,8% 12.566 20,6% 89.010 21,6%

2 119.086 33,9% 19.428 31,9% 138.514 33,6%

3 57.372 16,3% 11.266 18,5% 68.638 16,7%

4 53.942 15,4% 7.734 12,7% 61.676 15,0%

5 28.397 8,1% 4.673 7,7% 33.070 8,0%

6 9.732 2,8% 3.301 5,4% 13.033 3,2%

7 6.084 1,7% 1.979 3,2% 8.063 2,0%

Total 351.057 100,0% 60.947 100,0% 412.004 100,0%

Number of beneficiaries 2007

55,2 %

71,9 %


Total beneficiaries 2007: 411.976• Federal LTC beneficiaries: 351.057

• Provincial LTC beneficiaries: 60.919

Total cost of LTC benefit 2007 € 2.001,8 million

• Cost on federal level: € 1.691,5 million

• Cost on provincial level: € 310,3 million

Long-term care benefit No. of beneficiaries and cost


Financing of LTC servicesA basic model

beneficiaries

Federal government

Provinces/Municipalities

public providers

LTC-benefit

sick funds

other sourcese.g. donations, sponsors

medical home care only

NOTE: This is a general model only. Variations occur in every province.

social assistance for those who can’t afford co-payments

rewards on basis of service agreements

servi

ces

co-paymentsco

-pay

men

ts

serv

ices

private providers

informal care

services and financial supportsocial security for uninsured family carers


Financing of LTC services

Variations in Austrian provinces

Bgld. Knt. NÖ OÖ Szbg. Stmk. Tirol Vlbg. Wien

Minimum Nurse € 26,10 € 0,-/€ 7,- € 9,10 € 0,80 € 0,00

€ 6,69 € 3,80 € 22,00 € 0,00

per h NA € 20,80 € 0,-/€ 6,- € 9,10 € 0,80 € 0,00 € 4,87 € 3,00 member fee € 0,00

HH € 15,90 € 0,-/€ 8,- € 9,10 € 0,80 € 0,00 € 2,98 € 2,30 € 8,00 € 0,00

Maximum Nurse € 24,90 € 30,00 € 28,00 € 20,70 € 28,10 € 36,26 € 38,76 € 33,00 € 22,13

per h NA € 19,90 € 26,00 € 23,00 € 20,70 € 26,50 € 26,38 € 33,79 member Fee € 22,13

HH € 15,30 € 22,00 € 20,00 € 20,70 € 26,50 € 16,50 € 29,14 € 13,00 € 16,86

€ of LTC-benefit Nurse € 6,00 € 5,70 € 3,93 € 6,00 € 6,00 € 6,18

per h NA € 6,00 € 5,70 € 3,93 € 6,00 € 4,90 € 4,36

HH € 5,70 € 3,93 € 6,00 € 3,80 € 2,91

Also variations in• mode of client allocation (decentralised/centralised models)

• maximum extent of public supported service hours

• mode of accounting (e.g. rewards per service hours, service quota)

Variations in co-payments by beneficiaries


Cash benefits vs. non-cash benefits/services• Cost for cash benefits (2006): € 1.925,04 million• Cost for services/non-cash benefits (2006): € 1.332,34 million • forecast: cost for services will raise faster than cost for cash-benefits

Cost by territorial authorities• Cost on federal level (LTC-benefit, 2006): € 1.621,40 million• Cost on provincial level (2006): € 1.635,74 million• Cost on municipal level (estimation): € 400,00 million• Provincial expenditures will increase faster than on federal level

Public expenditures vs. private effort• Public expenditures in LTC (2006): € 3.257,38 million• Estimated value of informal care: € 2 – 3 billion• Estimated co-payments by beneficiaries: 550 million• No data on care-related private expenditures available

Financing of LTC services Structure of cost

Sources: WIFO (2008), Quantum (2007), Schneider et al. (2006)


Thank you for your attention!

ContactKurt SCHALEKÖsterreichische Caritas Zentrale (ÖCZ)Albrechtskreithgasse 19-21, A-1160 ViennaPhone: 0043 1 488 31-436eMail: [email protected]

Long-Term Care in Austria Home Care Europe Conference June 3 rd – 5 th 2009, Vienna Mag. Kurt...

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