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The Future Role of Residential Care Homes in the Health, Care and Nursing System The Perestroika of

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Prevention of delay of onset of disability ... LTC, acute care, public health, rehabilitation, mental health. Sectors. Health and Long-term Care ... – PowerPoint PPT presentation

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Title: The Future Role of Residential Care Homes in the Health, Care and Nursing System The Perestroika of


1
The Future Role of Residential Care Homes in the
Health-, Care- and Nursing System-The
Perestroika of Residential Care for Older People
  • Dr. Henk Nies
  • Vilans, Netherlands Centre of Expertise for
    Long-Term Care
  • Utrecht, The Netherlands

2
Presentation
  • Long-term care the concept, the context, the
    reality
  • Strengths, weaknesses, opportunities and threats
    (SWOT)
  • Opportunities and/or threats?
  • Options for the future perestrojka?
  • Concluding remarks

3
Long-term care the concept, the context, the
reality
4
  • The concept

5
WHO definition LTC (2000)
  • the system of activities undertaken by informal
    caregivers (family, friends and/or neighbours)
    and/or professionals (health and social services)
    to ensure that a person who is not fully capable
    of self-care can maintain the highest possible
    quality of life, according to his or her
    individual preferences, with the greatest
    possible degree of independence, autonomy,
    participation, personal fulfilment and human
    dignity

6
  • The context

7
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8
  • The reality

9
65 people in residential care() (source
Lamura et al., 2007)
10
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11
(No Transcript)
12
  • SWOT

13
Strengths
  • Cheap and efficient service delivery
  • Especially for people with poor self-direction
    and poor social network
  • Supervision around the clock
  • Safety and security
  • Strategic value of dwellings

14
Weaknesses
  • Negative image last resort, poor quality

15
Quality issues (OECD, 2005)
  • Inadequate housing
  • Lack of privacy

16
Privacy (OECD, 2005)
17
Quality issues (OECD, 2005)
  • Inadequate housing
  • Lack of privacy
  • Poor social relationships
  • Inadequate treatment of depression, chronic pain
  • Bedsores
  • Restraints
  • Elder abuse/neglect

18
Weaknesses
  • Negative image last resort, poor quality
  • Institutionalised service
  • Poor consumer direction
  • Stand alone position
  • Understaffing (quality, numbers)
  • Under-funding
  • Under capacity/waiting lists access
  • Preference older people to stay at home!

19
Opportunities
  • Ageing of the population and reduced availability
    of informal care
  • Prevention of delay of onset of disability
  • Private payments and prosperity of a part of the
    population
  • Integration chains of care
  • Housing context/real estate
  • Technology
  • Non-care qualities

20
Care farms
21
Threats
  • Poor quality (care, staff and dwellings)
  • Poor budgets/low coverage
  • Poor clients financial burden
  • Labour market
  • Poor quality of management
  • Quality strategic, managerial
  • Avoidance of risk taking behaviour
  • Todays problems prevail
  • Sustainability

22
System reforms Opportunities or Threats?
  • Continuity of care (connecting administrative
    levels, public-private, services)
  • Market mechanisms
  • Transparency quality visible (indicators)
  • Pay for performance or funding outcomes (less
    funding inputs)
  • Consumer direction personal budgets/cash
    allowances

23
Current debate in system reforms
  • Balance between state and private (and/or
    voluntary) sector in provision
  • Balance between family and state public and/or
    private
  • Who cares labour market and mobility
  • Who pays?
  • Sustainability

24
Who cares for older person when primary family
carer stops? (source Lamura et al., 2007)
25
Working adults should look after elderly parents
(in ) (source Lamura et al., 2007)
26
Households employing privately paid home care
workers (in )(source Lamura et al., 2007)
27
Home care (migrant) workers in Italy (source
Lamura et al., 2007)
with foreign Total nationality
1991 181.096 35.740 16,5 1995 192.942
67.697 35,1 2000 256.803 136.619 53,2 2001 261
.390 142.196 54,4 2002 224.243 147.328 65,7 200
3 588.701 490.678 83,3 2005 700.000
600.000 86,0 estimates
28
Opportunities or Threats? Older people
  • Rising number of older people who pay for their
    own care
  • Impact of direct payments, individual budgets
    how do they spend their money or what will they
    chose?

29
Denial of residential care as future option
(in)(source Lamura et al., 2007)
30
Older people Opportunities or Threats?
  • Older people who pay for their own care
  • Impact of direct payments, individual budgets or
    what will they chose?
  • Less informal carers ? less informal care
  • Voters power?

31
Options for the future perestroika?
  • Consumer direction and normalisation quality of
    life as dominant paradigm (shift)

32
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33
Options for the future perestroika?
  • Consumer direction and normalisation quality of
    life as dominant paradigm (shift)
  • Integrated concepts

34
Empowerment
Housing
Multi- disciplinary Team
Single point of entry
Needs assessment/ Service plan
Respite care
Case management
Joint budget
Information system
35
What should be integrated?
  • Self-care, informal care and professional care
  • LTC, acute care, public health, rehabilitation,
    mental health
  • Sectors
  • Health and Long-term Care
  • Housing
  • Technology
  • Neighbourhood development
  • Social care and welfare
  • Social protection.

36
hospital
nursing home
residential home
day centre
sheltered housing
district nursing
home help
life cycle proof housing
informal care
self care
volunteers
independent living
37
Options for the future perestroika?
  • Consumer direction and normalisation quality of
    life as the dominant paradigm
  • Integrated concepts
  • No recipe for all countries
  • Intermediate care, respite care
  • Rehabilitation and prevention
  • Care for the carers and care for the care workers
  • Social relationships, group housing
  • Dementia care
  • Small is beautiful!
  • Home improvement
  • Technology

38
  • Act as if it can be your future!
  • Thank you!
  • h.nies_at_vilans.nl
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