The Flemish model, a multiplicity of Home Care organizations Sarah Willockx

Belgium: Politics and society structure of state Federal state Federal state  Competent for specific matters such as ‘social security’ 3 communities: Flemish, French-speaking, German- speaking community 3 communities: Flemish, French-speaking, German- speaking community  Competent for personal matters such as education and welfare

Flemish or Dutch-speaking community French- speaking community German- speaking community Communities

The social security system Totally elaborated system: Totally elaborated system:  Elderly pensions  Unemployment benefits  Family allowances  Sickness and disability insurance 2 pillars 2 pillars  insurance principle  solidarity principle Control and organisation by federal state Control and organisation by federal state

per age group of 5 years and per inhabitants Source: Demographic context

Door-to-door care for costumer Door-to-door care for costumer Support proximity aid Support proximity aid Promote independency Promote independency Non-commercial point of view Non-commercial point of view No exclusion based on risk, financial situation, race or conviction No exclusion based on risk, financial situation, race or conviction Home Care services in Belgium Purpose

Nursing tasks Nursing tasks Help with: Help with: - everyday personal hygiene - medical care Specialized tasks by specialized nurses Specialized tasks by specialized nurses Federal home nursing Job contents

Personal hygiene Personal hygiene Domestic help Domestic help Cleaning help Cleaning help General psychosocial and pedagogical support General psychosocial and pedagogical support Job contents Non-medical home services

Growing demand for logistic help and additional home help Growing demand for logistic help and additional home help Cleaning help, odd jobs and sitting services + general psychosocial and pedagogical support Cleaning help, odd jobs and sitting services + general psychosocial and pedagogical support Wallonia: elaboration in progress Wallonia: elaboration in progress Flanders: own rules already applied Flanders: own rules already applied Job contents Logistic services

Cleaning, ironing and cooking at home of costumer Cleaning, ironing and cooking at home of costumer Also ironing, transport or shopping services Also ironing, transport or shopping services Employment measure Employment measure Fight illegal work Fight illegal work Support families with two partners out working Support families with two partners out working Accessible for everyone: with or without need of care Accessible for everyone: with or without need of care Job contents Service vouchers

Medical care: doctor’s prescription Medical care: doctor’s prescription Personal hygiene: No prescription GP Personal hygiene: No prescription GPKatz-scale Conditions & accessibility Home nursing

No formal reference No formal reference Contact by: costumers, proximity caretakers or 3rd persons (GP, social service hospital) Contact by: costumers, proximity caretakers or 3rd persons (GP, social service hospital) Social examination by social worker Social examination by social worker Conditions & accessibility Non-medical home care services

No fixed rules No fixed rules Often same procedure as non-medical home care Often same procedure as non-medical home care Conditions & accessibility Logistic services

Target group: able-bodied healthy people Target group: able-bodied healthy people Apply at certified organization Apply at certified organization Exception in Walloon part: also for Exception in Walloon part: also for non-medical home care services Service vouchers Conditions & accessibility

Qualified nurses: bachelor, master or registered Qualified nurses: bachelor, master or registered Reference nurse Reference nurse Wage earning or self-employed Wage earning or self-employed Organization & caregivers Home nursing

Caregiver: certificate regular daytime classes or adult education Caregiver: certificate regular daytime classes or adult education Wage earners for a certified home care service Wage earners for a certified home care service Organization & caregivers Non-medical home care services

Flanders: no specific certificate Flanders: no specific certificate Wallonia: sitting services require certificate of professional caregiver Wallonia: sitting services require certificate of professional caregiver Organization & caregivers Logistic services

No specific certificate No specific certificate Employed by a certified firm Employed by a certified firm Certified firms: commercial or non-commercial Certified firms: commercial or non-commercial Steady job Steady job Service vouchers Organization & caregivers

Federal matter< social security Federal matter< social security Subsidies rating per nursing act Lump sum: based on degree of need of care Lump sum: based on degree of need of care Third party system: user pays nothing Third party system: user pays nothing Share of beneficiary can be charged Share of beneficiary can be charged Legal & financial framework Home nursing

Community matter Community matter Public and private services Public and private services Flanders: quota of subsidized hours based on programming figures Flanders: quota of subsidized hours based on programming figures Wallonia: subsidies per geographic zone & per service Wallonia: subsidies per geographic zone & per service Wallonia: limited 200 hours per user / trimester Wallonia: limited 200 hours per user / trimester Flanders: no limitation Flanders: no limitation Legal & financial framework Non-medical home care services

User contribution per hour depending on income and family situation: User contribution per hour depending on income and family situation: Flanders: 0.5 €  cost price Gravity of need = reduction possible ( average 3.5 €) Wallonia:0.9 €  8 € (average 2.60 €) Legal & financial framework Non-medical home care services

Community matter Community matterHow? Flanders: envelop financing on annual basis per full time equivalent Flanders: envelop financing on annual basis per full time equivalent Wallonia: no specific financial framework Wallonia: no specific financial framework user pays small contribution based on income and family situation Legal & financial framework Logistic services

Federal matter Federal matterHow? fixed wage fixed wage User buys voucher of 7.50€/hour User buys voucher of 7.50€/hour Fiscal advantage of 30% (2.25€/hour) Fiscal advantage of 30% (2.25€/hour) Voucher is worth 20.80€ for the employer Voucher is worth 20.80€ for the employer Financed by federal government Financed by federal government Legal & financial framework Service vouchers

Types of services not unrelated Types of services not unrelated Disciplinary and multidisciplinary consideration Disciplinary and multidisciplinary consideration Structured formal consideration Structured formal consideration Multidisciplinary collaboration & consultative bodies

Ageing and declining population Ageing and declining population Solidarity principle under pressure? Solidarity principle under pressure? Market developments Market developments Job demarcation and competences Job demarcation and competences Challenges