Home-based or residential care in the EU: issues … problems

Home-based or residential care in the EU: issues …

problems

((FERPA Executive Committee, Brussels, 29 October 2013FERPA Executive Committee, Brussels, 29 October 2013 ))

1Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07/ +32/(0) 477 98 05 33 - e-mail: [email protected]

This talk falls into three parts First, a short review of the different forms of

care provision for those with decreasing independence

Then a more extensive look at problems found to exist with residential and home-based care

And to conclude, a brief outline of possible lines of trade union action to be added to and filled out in this and future discussions

2Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07 / +32/(0)477 98 05 33 - e-mail: [email protected]

The situation in Europe: The situation in Europe: Forms of care provision for Forms of care provision for

decreasing independencedecreasing independence

3Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07 / + 32/(0) 477 98 05 33- e-mail: [email protected]

• Conditions for accessing care provision for decreasing Conditions for accessing care provision for decreasing independenceindependence

• Access to care provision for decreasing independence (social care) is generally not age-dependent

• EXCEPT, particularly in France (60) and the United Kingdom (65)

• In the Netherlands, compulsory AWBZ insurance covers both the dependent elderly and those with a chronic disease or (physical or mental) disability. Payment of care by the dependency insurance scheme is determined by the duration of care needs

• Germany’s Social Welfare Code (SGB) covers persons with a physical, mental or psychological illness or disability; the criterion is duration of care (longer than 6 months) and significant assistance in performing activities of everyday living

• In Spain (Law of 14 December 2006) dependency is defined as needing assistance from one or more persons to perform the basic activities of living (due to age, illness or disability)

• In Sweden, the approach is based not on dependency but on "needs" ...


• Priority to home-based care...

• Which is what people in all countries want ...

• Given the generally negative connotation of “being taken into care”: when there is absolutely no alternative ...

• Priority is given everywhere to home-based care (70% on average, OECD study)

• Rather than “being put into care" (30%) ...

• Belgium still has a relatively high rate of residential care (45% of cases)

• In Sweden, since 2000. the trend has been to “community-based care": the number in residential care has declined by 12% in 8 years

- 37% in residential care and 63% receiving home-based care in 2008

• In the Netherlands, the proportion of people over 80 in residential care has fallen from 50% in 1980 to 30% in 2008 ...


• The key reasons…• As we have seen, to address what care recipients want• But also for reasons of cost control…• In all countries, the share of GDP (wealth) allocated to residential

care > that allocated to supported home-based care in inverse proportion to the % of population concerned:

• - Germany: 0.8% and 0.5%• - Spain: 0.5% and 0.4%• - France: 0.9% and 0.3%• - Luxembourg: 0.9% and 0.4%• - Belgium: 1.2% and 0.5%...


• What forms of residential care provision?…• “Halfway house” provision: purpose-designed

accommodation of the “care home” type providing services appropriate to residents’ needs (meals, care staff if needed, etc.) intended to avert isolation

• These are found in the Netherlands, Sweden, Denmark, Belgium, etc…

• “Day care centres”: Italy, Spain, United Kingdom…• Specialised provision, increasingly prevalent with age: 2

countries stand out for the fact that more than 50% of people aged over 80 are in residential care (compared to 30 to 40% elsewhere)


The problems of The problems of “residential” care“residential” care


A study (European Foundation) highlights the problems with accessing residential care:

- cost (60% of respondents) - supply of places (61%) - physical accessibility (distance, opening hours) 49% - quality (44%) But other, equally problematic issue, are to be found: - risk of abuse - staff numbers and qualifications


One big problem with residential care is its cost to the care recipient:

- In the United Kingdom: the average cost (2010) was 35,000 Euros/year and about 50,000 in a care home with nursing

- In Italy, the cost ranged from 1528 Euros/month to 2702 Euros for a care home with nursing

- In Germany, the average cost of a retirement home is 3300 euros per month, although much of that is paid for by long term care insurance

This results in an often high “co-payment” charge (excluding health expenditure)

- 31% of total expenditure in Germany - 25% in Spain - In France, the average cost of long term care is 1.5 x the

average pension


What role for the private sector?

Currently, little to very little (labour-intensive sector) - apart from France: in 2010, 15% of over-40s had long-term care insurance - and Germany: 1.8% of long-term care spending is met from private

insurance Two types of insurance product: - ”lump sum”: a fixed amount paid where the beneficiary meets the

requirements for long-term care (France, United Kingdom with Immediate Care Plans and Immediate Needs Annuities)

- “compensatory”: compensation intended to cover (all or part) of spending on long-term care

But what does the future hold ? - foreseeable increase in demand (partly due to population trends) - combined with the cap on public spending on care (financial and

institutional…)


The second issue is accessibility (availability of beds)

Resulting in long waiting listsOr unmet demand: In the Netherlands, one in two applications

goes unfulfilledDitto SwedenWhich paradoxically leads to certain States

rethinking their policy of closing beds, as happened in the first decade of the 2000s


Problems with access stem to a great extent from Member States (self?) imposed budget constraints

Reflected in capped investment in new residential provision

These constraints also impact on the quality of life and care in residential provision

Connected with staff working conditions: fewer staff, less time to spare or to undergo training

-


The risk of abuseThe risk of abuse

- Data on its prevalence are sparse, but studies report that 20 to 30% of elderly residential and home care recipients may have suffered abuse (estimated at between 4 and 6%)

- The The forms of abuse in care homes:

- Physical violence: the most visible because leaving most marks but not the most common (blows, burns, pushing over, restrictions on freedom of movement like bed pindown, etc…)

- Psychological violence: most common (bullying, insults, humiliation, etc…)

- Financial violence (denying the care recipient their own resources), also quite common (stealing money or goods, misappropriating a pension, anticipated inheritance, etc…)

- Civic violence (abuse of authority): enforced putting into care, misuse of power of attorney, etc…)

- Drug abuse (excessive administration of antipsychotics or conversely, denial of prescribed medicines…)

- Neglect (abandonment of someone unable to care for themselves, deprivation of food, denial of care or hygiene, etc…)

- 14Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07 / +32/(0)477 98 05 33 - e-mail: [email protected]

The causes…The causes…

Connected with how the institution works

- The “house rules” which are often restrictive and ignore residents’ individuality (tastes, culture, lifestyles…), such as mealtimes, waking up times and bedtimes

- The organisation of care or non-coordination of care

- Often, residents and/or their families are not represented on the home’s governing bodies (meetings held in private)…

- Connected with staff and chiefly affecting caregivers

- - under-staffing (excessive care workload, absenteeism, or profit maximisation…)

- - unskilled staff (shortage of nurses…)

- - lack of communication (families, residents and staff)

- - stresses of work undervalued by society (→ absenteeism and staff turnover)

- - “burn-out” (feelings of being worn-down, exhausted and unable to carry on due to excessive demands on energy, strength or resources)


Issues with home-based care Issues with home-based care As has been said, in all countries, especially,

because of the budget issues mentioned,

but also because it is what older people and their families want,

The priority is home-based care

e16Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07 / +32/(0)477 98 05 33 - e-mail: [email protected]

Who provides home-based care?Who provides home-based care? 80% of home-based care hours in the EU are

provided by families or informal carers

20 million carers work more than 20 hours a week

Most are women aged over 45

But some are also immigrants, often illegal, undeclared female carers (In Italy: “badante” or “badanti”)


However, these “However, these “carers” lack… Training, and so often (fear to …) make mistakes

They also lack “social recognition” (social security/employment rights, carers’ respite leave…)

Help

and forms of support

What linkages exist with the “formal” caregivers (nurses, social workers, doctors…)?


There is a risk of seeing this form of “family” There is a risk of seeing this form of “family” caring dying out/changing …caring dying out/changing …

The changing role of women in society

Shrinking family sizes

Changing family structures (divorce rates, blended families, moving for work…)

Increased female labour force participation

Pensions reform (e.g., increase in women’s contribution qualifying periods)

More people with more complex disabilities and needs …

…Requiring greater technical and social skills…


Possible lines of Possible lines of trade union inquiry trade union inquiry

and actionand action


Obstacles to overcome for personal services Obstacles to overcome for personal services workers …workers …

It is a sector lacking in “visibility” Resulting in low status and recognition for workers in this

(female-dominated) sector A sector (excluding medical care) seen as inherently low-skilled Jobs usually low-paid No career prospects High turnover of seniors-in-charge Predominantly non-standard employment: (very) short hours;

(very short) fixed-term … Duties assigned without reference to staff needs

21Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07/ +32/(0)477 98 05 33 - e-mail: [email protected]

For home-based carers…

Not see it in terms of home-based versus “professional” carers, but as complementing one another (changing needs of care recipients…)?

Plan in reductions of duties/breaks for carers (the Netherlands has day or night attendance schemes, Sweden has respite care provision, for example …)?

Ensure minimum social/employment rights: caring tasks recognised for accruing pension entitlements, or as in Germany: long-term care insurance cover for sickness and even holidays up to 4 weeks and a maximum payment of €1,470 a year …?

Set up support schemes: like counselling groups, wellness activities, self-help groups…?

22Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07 / +32/(0) 477 98 05 33 - e-mail: [email protected]

By way of conclusion…

These are not fixed lines of inquiry but options that need to be discussed

and are not by any means exhaustive; they need adding to

They aim only: to set going and inform the debate on the basis of shared findings

23Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07/ + 32/(0) 477 98 05 33 - e-mail: [email protected]

Thank you for your attention

• Remarks?...Remarks?...• Questions?...Questions?...• Reactions?...Reactions?...

24Bd du Roi Albert II, 5 - B - 1210 Bruxelles Tel: +32/(0)2/224 04 07 / +32/ (0) 477 98 05 33 e-mail: [email protected]

Home-based or residential care in the EU: issues … problems

Documents

homebased care

payment of care

communitybased care

care recipients wantbut

high rate of residential

roi albert

bruxelles tel

decreasing independencethen