Who Cares?
Care coordination and cooperation
to enhance quality in elderly care
in the European Union
Conference on Healthy and Dignified Ageing
Swedish Presidency of the EU
15-16 September 2009
Prof. Dr. Bernd Marin
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
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
2
Long-term care: a late-comer
 “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.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
3
How many receive care in institutions?
Share of older people receiving care in institutions (most recent date)
Institutional care
covers only a small
percentage of older
people
6.5%
Source: Huber et al. (2009 forthcoming) Own calculations based on OECD, NOSOSCO , WHO, Eurostat and national
sources.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
4
Home is where you’re cared for
Share of older people receiving long-term care services at home (most recent date)
Different approaches
to care
Source: Huber et al. (2009 forthcoming) Own calculations based on OECD, NOSOSCO , WHO, Eurostat and national
sources.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
5
Providing more people with care
Share of older people receiving care at home and in as institutional setting (most recent date)
Publicly provided
care at home:
the key for wider
access to care
Source: Own calculations based on OECD, NOSOSCO , WHO, Eurostat and national sources.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
6
Differences in informal care giving
Percentage of the population aged 15+ providing informal care to a co-resident relative aged 60+ (1999)
Labour
of love
Intimacy at
a distance
Source: Huber et al. (2009, forthcoming) Own calculations based on Walker (1999).
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
7
Overburdened carers
EUROBAROMETER (2007) In your opinion, do dependent older people rely too much on their relatives?
Lack of care
services…
Providing care
to co-residents…
… explaining
carers’ burden?
Source: EUROBAROMETER (2007)
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
8
Mid-life challenges
Providing care for older family members by country and age group
Source: OECD (2005), EUROFAMCARE national reports.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
9
Reconciling work and care
On an
individual level:
remains difficult
Employment status of main carers by country and domain
On a policy
level:
can the Lisbon
Strategy and
support to
carers co-exist?
Source: National sources, EUROFAMCARE national reports, Lamura et al. (2006).
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
10
How much and where are we spending?
Public expenditure on long-term care and its distribution between home and institutional
care (most recent date)
Paradox:
most people
cared for at
home...
... most public
resources
devoted to
institutional
care
Public resources:
 A diverse picture
 Modest amounts
dedicated to care:
EU15 spends 7.6%
on health and 9.1%
on old-age pensions
alone
Source: Huber et al. (2009, forthcoming) Own calculations based on OECD,
NOSOSCO , Eurostat and national sources.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
11
Making sense of differences in expenditure
Relation between expenditure on old-age institutional care and share of
older people benefiting from it, 2007
Different
private public
mixes in
expenditure
Differences in
quality
Source: Huber et al. (2009 forthcoming) Own calculations based on OECD, NOSOSCO, Eurostat and national sources.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
12
How deep is the beneficiaries’ pocket?
User’s fee for institutional care, in percentage of the APW net wage (2007*)
Paying for
institutional
care (EU level):
51.2% of public
resources
devoted to 3.3%
of 65+...
... yet, heavy
private
contributions
still required.
Source: Huber et al. (2009 forthcoming) Own calculations based on national sources.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
13
Trade-offs in benefit generosity
Amounts of attendance allowances in percentage of net wage of APW and its beneficiaries
(2007 or most recent date)
Higher but
targeted amounts
“Generous”?
Smaller portions
of the pie
Source: Huber et al. (2009, forthcoming).
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
14
The challenge of coordination and integration
Overcoming
barriers
Nurs
Gener
ing
al
Hospital
Hom
Practiti
e
oner
Care
Health Care System
differentiated, professionalised,
hierarchical, funded, rights-based
Short Day
term Care
Care
Resident
ial Care
Other
Home Services,
Help Housing,
etc.
Social Care System
local, less professionalised,
badly funded, discretional
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
15
An example of good practice
Skævinge (Denmark): The Health Centre ‘Bauneparken
24-hour integrated
health and social care
Short
term
Care
Hospital
General
Practitio
ner
Residential
Care
Nursin
g
Home
Care
Home
Help
How:
 Person-centred
 Single point of contact
 Case management
 Self-care and prevention
15-16/09/2009
Day
Care
Other
Services,
Housing,
etc.
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
Outcomes:
 No waiting time
 Room for
specialized services
 Reduced hospital
stays
 Below average use
of resources
16
Accessing mainstream health
 Dependent older people facing barriers in access
Low
expectations
Regulations
Age
discrimination
Mobility
Poverty
Gaps in geriatrician’s
training
 Major improvements should be possible in rehabilitation
and mental health
 Specialised research in health care for older people needed
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
17
Having a choice on care
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?
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
18
Long-term care workforce
 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
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
19
Alzheimer and other dementia
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).
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
20
Privacy in care home
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)
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
21
Future ageing in the older age groups
Current and projected share of the population aged 80+, 2006 and 2050 (selected countries)
Huber et al. (2009) based on Eurostat EUROPOP2008.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
22
Ageing and public expenditure
in long-term care
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.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
23
Trade-offs in benefit generosity
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).
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
24