Top Banner
“Integrated social and health services for older people: an italian example (Emilia- Romagna) ” Raffaele Fabrizio Bishkek, April 10 th 2015
26

Integrated social and health services for older people: an italian example (Emilia-Romagna)

Jul 18, 2015

Download

Third Sector
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Integrated social and health services for older people: an italian example (Emilia-Romagna)

“Integrated social and health services for older people: an ital ian example (Emil ia-Romagna) ”

Raffaele Fabrizio

Bishkek, April 10 th 2015

Page 2: Integrated social and health services for older people: an italian example (Emilia-Romagna)

CENTRAL Goverment-Pension National care allowance

-National Health system Standard professional skills

- National FUND

- compulsory standard of care

REGION Organisation regional health care

Social services planning (rules, standard, funding):

authorization

accreditation

network (public and private) coaching

Local Authorithies-Needs assestment -planning service with public fund support

-use of resource ules for copayment

-- contracting with providers monitoring quality

Page 3: Integrated social and health services for older people: an italian example (Emilia-Romagna)

•About 450€ per month - criteria: 100% disabled people, need to be helped for ADL (activities day life)

•No income’s limits

•No control about how the money is used

•No link with services' network

• PEOPLE RECEVEING NCA:

Italy: about 1,2 mln people =>65years old (about 6 milliards Euros per year)

Emilia-Romagna 103.000 people: 10% of =>65years ; 20% of =>75years , about 600 millions € per year

NATIONAL FUND? THE NATIONAL CARE ALLOWANCE (NCA)

Page 4: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Changes in the context: changes in the life

Pension system Recent changes in the pension system

Current average age at retirement

59,5

Prospective average age at retirement

67

Number pensioners in ER (2012)

% pensioners % pensionars on less than euro 1.000/month

National average monthly pension

1.331.283 30 40 832 euro

Page 5: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Local authorithies categories per number of

inhabitans(to 01.01.2014) Number People %

Up to 1,000 21 15.016 0,3

From 1,001 to 5,000 135 399.926 9,0

From 5,001 to 30,000 171 1.877.547 42,1

From 30,001 to 100,000 12 575.429 12,9

> 100,000 9 1.591.328 35,7

EMILIA-ROMAGNA REGION

Inhabitants: 4.459.246 1.1.2014

9 PROVINCES 348 MUNICIPALITIES

Page 6: Integrated social and health services for older people: an italian example (Emilia-Romagna)

EMILIA-ROMAGNA:context data

Page 7: Integrated social and health services for older people: an italian example (Emilia-Romagna)

ECONOMICS

GDP per capita 2013E-R 32.500E-R 32.500Italy 26.400Italy 26.400EU 28 27.000EU 28 27.000

From ISTATFrom ISTAT

Unemployment rate 15-64 2013

Total Total E-R 8,5%E-R 8,5%Italy 12,2%Italy 12,2%

EU28 10,8%EU28 10,8% Older persons employment rate, persons

aged 55 to 64 years, Lisbon strategy Goal 50%

Italy 30 ER 40

Page 8: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Elderly : not only costs. elderly helps helderly volunteers and not only elderly (grandfather and grandmother «canguro»)646,520 at regional level (55,4% male – 44,6% female)

14,5% of total population Age of volunteers total % % in class 18-64 years 512.756 79,3% 19,3=>65 years 133.764 20,7% 13,6

services for elerderly also an economic opportunity

Page 9: Integrated social and health services for older people: an italian example (Emilia-Romagna)

MOBILITY

Great help to elderly people is provided by social transport (to health services, cultural and social events, etc.) run by volunteer organisation (mainly by retired people)

Social transport by volunteers (2010)

Hours 1.171.803

Number transports 550.071

km 11.697.416

Page 10: Integrated social and health services for older people: an italian example (Emilia-Romagna)

EMILIA-ROMAGNA REGION: DEMOGRAFIC TRENDS

1981 2001 2005 2013 2020

=>65 16,4 22,2 22,7 22,8 22,2 =>75 5,8 10,7 11,3 11,9 11,7 =>80 2,8 5,9 6,6 7,3 7,5

1981 1991 2001 2008 2013 2020

0-14 671.248 447.907 470.293 547.512 560.379 595.193 60-64 201.308 259.049 266.191 254.930 269.357 275.325

65-69 226.727 252.898 239.830 252.548 248.534 246.352 70-74 187.209 167.540 224.557 227.191 239.643 241.443 75-79 120.567 167.056 196.819 196.640 205.450 194.509 > 80 108.844 178.021 236.259 291.829 324.426 346.567 Total 3.922.388 3.909.512 4.037.095 4.275.843 4.471.104 4.635.400

Page 11: Integrated social and health services for older people: an italian example (Emilia-Romagna)

 E-R Italia UE 25

% 0-14 anni 12,3 14,1 16,2

% 65 anni e più 22,8 19,5 16,7

% 75 anni e più 11,9 9 7,6

% 80 anni e più 7,3 5 4,1

Aging Index 167,9 147,2 112

EMILIA-ROMAGNA REGION: AGING INDEX

E-R

Page 12: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Resident population

Total males Foreign males Total females Foreign females

- 53% of foreign population between 20 & 45 years old

- Under 18 are increasing (23%)

GENDER

NATIONALITY

AGE

Age structure of the population residing in the ER by gender, citizenship and single year of age, 01/01/2013

Page 13: Integrated social and health services for older people: an italian example (Emilia-Romagna)

•REGION: (Health services and FRNA)

•ELDERLY: (people and families, including us of NCA)

•LOCAL AUTHORITIES

WHO PAYS THE COST OF SERVICES?

NATIONAL FOUNDS?

40%

40%

20%

Page 14: Integrated social and health services for older people: an italian example (Emilia-Romagna)

AN integrated system:Not only social and health

The mainly problem: integrate all local policies(urbanistic planning, housing, transport, long life learning, tourism, social and health)

FOCUS NOT IMPROVING ADMINISTRATION BUT ON THE SINGLE INDIVIDUAL.

Page 15: Integrated social and health services for older people: an italian example (Emilia-Romagna)

FRAIL ELDERLYMultifactor approach

health problems,

functional deficit,

social context,

incomes

loneliness

no close relations

No possible a general model without context analysis

Page 16: Integrated social and health services for older people: an italian example (Emilia-Romagna)

0

4

8

12

16

20

24

28

32

36

40

44

Meno di 25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 e oltre

% M in unip %F in unip % MF in unip

% total population

11,5%

% =>75 34%

% =>85 38%

% Femm =>85 46%

FAMILIES COMPOSED BY ONLY 1 PERSON (BY AGE

GROUPS)

Page 17: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Services network for Services network for

Not-selfsuff icient Not-selfsuff icient elderly people elderly people

Page 18: Integrated social and health services for older people: an italian example (Emilia-Romagna)

SENIORS HEALTH:

3 LEVELS OF INTEGRATION

INSTITUTIONALAGREEMENT BETWEEN

MUNICIPALITY AND AUSL

ORGANIZATIONAL-OPERATING SENIOR ASSISTANCE SERVICE (SAA)

Case manager

Local Geriatrical evaluation Unit

(UVGT)

PROFESSIONAL

Page 19: Integrated social and health services for older people: an italian example (Emilia-Romagna)

GERIATRICAL EVALUATION

UNIT (UVG) •GERIATRICIST•NURSES

•SOCIAL WORKERS

•MULTI-DIMENSIONAL EVALUATION•INDIVIDUAL PLAN (PAI)•PROPOSAL USING SERVICES•FOLLOW UP

GP

OTHER SPECIALISTS

Integrated Home care

Nursing homes =CRA

Caregivers and family assistant

supporting

Day centers= CD

Page 20: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Total no. of

services

Users per service

% of services

per =>75

population

Providers

Public

Private

non- profi t

Privatefor-

profi t

TOTAL

Residential(nursing homes)

328 17.556 3,1% 89 186 53 328

Day Care Center

215 3.342 0,6% 92 108 15 215

Regional Care Allowance

20.500 people

4 different levels in relation to the level of care provided by relatives: 280, 450, 700, 1050 euro per month

Home care services

129 24.207 30 99 0 129

Day social activity center 354 Center 135.000 Members

Volunteer Association

SERVICES FOR THE ELDERLY in Emil ia Romagna Region

National Care Allowance 105.000 (=>65 years)

490 euro per month In ER 600.000.000 euro per year

Page 21: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Women from foreign Women from foreign countries (mainly Eastern countries (mainly Eastern European) take on the task European) take on the task

of caring for elderly and of caring for elderly and disabled people, sharing the disabled people, sharing the

same home.same home.

How ointegrate family How ointegrate family assistant in the network?assistant in the network?

How to reduce black market How to reduce black market for home care?for home care?

Family assistants

Page 22: Integrated social and health services for older people: an italian example (Emilia-Romagna)
Page 23: Integrated social and health services for older people: an italian example (Emilia-Romagna)

• Integration of all actorsIntegration of all actors

Some lessons we learnt

• Access system:Access system: Single door systemSingle door system

Mult idimensional evaluationMult idimensional evaluation Case managmentCase managment

• Support caregivers and family Support caregivers and family assistantassistant

TraningTraning Respite care servicesRespite care services

Care allowanceCare allowance Support self help groupSupport self help group

Page 24: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Some lessons we learnt

• Planning specific approach for Planning specific approach for emergencies:emergencies:

Hospital discharge Hospital discharge Suddenly changes health or in the Suddenly changes health or in the

support ing familysupport ing family Climate emergency (heartquacke)Climate emergency (heartquacke)

• Provide services Provide services

• Integrated data systemIntegrated data system

• Innovation in soft, f lexible and community Innovation in soft, f lexible and community services and opportunit iesservices and opportunit ies

Page 25: Integrated social and health services for older people: an italian example (Emilia-Romagna)

Some lessons we learnt

• Professional integration:Professional integration: Good training for specif ic skil l Good training for specif ic skil l

Training and upgradeTraining and upgrade Common approach and language for all Common approach and language for all

professionalsprofessionals Common training on good relation with Common training on good relation with

elderly people and thei relativeselderly people and thei relatives

Page 26: Integrated social and health services for older people: an italian example (Emilia-Romagna)

THANK YOU FOR YOUR ATTENTION

[email protected]