1. Long-term care in Europe – discussing trends and relevant issues 22-23 February 2010  Budapest, Hungary Coordination and Integration of Health and Social Care for Older Persons Challenges and Solutions Kai Leichsenring European Centre for Social Welfare Policy and Research  Szocialpolitikai es Munkaugyi Intezet (SZMI)

2. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Aims of the presentation  to outline challenges for the coordination and integration of long-term care  to identify potential solutions for coordinating and integrating care  trends in long-term care governance  new methods in managing long-term care services  to present practical examples for enhancing coordination and integration

3. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Towards an integrated system of long-term care Integrated long-term care system Users/clients/ patients/citizens Health care system Social care system Services Residential care Providers Professions Methods Legal Framework Policies Hospitals Services Providers Professions MPs Methods Legal Framework Policies Vision - Culture - Strategies - Policies – Financing - Methods Processes - Quality criteria - R&D - Training

4. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The challenge: Overcoming barriers Health Care System differentiated, professionalised, hierarchical, funded, rights-based Social Care System local, less professionalised, badly funded, discretional Hospital  General Practi- tioner Nur- sing Home Care Short term Care Home Help Other Services, Housing, etc.  Residential Care  Day Care

5. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The challenge: Financing long-term care (at home) ATDEDKFRFIITNLUK National State (general taxes) 60%30%50%24%30% Social Insurance covering LTC 1%40%84% Regional government (Social Assistance) 20% Local government (Social Assistance) 95%20%64%50% Consumer19%20%(5%)10%12%16%20% Other sources (incl. Health System) 10%20%50%

6. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Governance of long-term care: Different national approaches  Introducing specific national legislation  Subsidizing bottom-up reforms  Reforming institutional care  Boosting market mechanisms  Supporting consumer-directed services  Promoting ‘demand-driven’ policies?

7. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Practical tools and methods 1: Towards coordination? ATDEDKFRFIITNLUK Case and care management Intermediate care Multiprofessional needs assessment and joint planning Consumer directed services Joint working

8. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Practical tools and methods 2: Towards coordination? ATDEDKELFRFIITNLUK Admission prevention and guidance Integrating housing, welfare and care Integration of family carers Independent counselling Coordinating care conferences Quality management

9. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Pathways to enhanced coordination 1 The interface between nursing home care and other social services Greece - UK - Germany Austria - Finland - NL France Nursing Home Care Home Help other services: meals- on- wheels, etc.

10. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The case of Helsinki (Finland): Integrated home care for older persons living at home  Type of integration  a multi-professional team of 6-10 nurses, home helpers, a home-care nurse and a chief home care officer (case manager) in a district of 350 clients  Methods  first visit (assessment) at the home of the older person (family members)  care and service plan: medication, home care services to be provided, frequency (days and tasks), rehabilitation plan  defined carer: every client has his/her ‘own’ carer  regular team meetings, documentation  common space for formal and informal meetings  continuous assessment of the care process

11. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Pathways to enhanced coordination 2 The interface between acute and long-term care Italy - UK - Denmark - Austria - Finland - NL - France Hospital General Practi- tioner Nursing Home Care Home Help

12. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The case of Vienna (Austria) Discharge management  Type of integration/coordination  To foster cooperation between hospital and home care service providers  To offer individual services for limiting the stay in hospital  Methods  Delegation of organising and coordinating the provision of home care to a discharge manager  Results  Tailored support arrangements  Promotion of mutual understanding between stakeholders  Reduction of length of stay from 13.3 days to 9.3 days in the ward of internal medicine within two years  Professionalisation of discharge managers

13. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The case of Dartford (United Kingdom) Rehabilitation upon discharge  Type of integration/coordination  Intermediate care  Horizontal and vertical integration to reduce pressure on acute hospital beds and to help patients manage at home  Methods  Multi-disciplinary assessment, therapy  Care manager and generic rehabilitation worker  Results  Effective rehabilitation assessment  Increased staff and user satisfaction  However: continuing problems of financial and contractual differences

14. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Pathways to enhanced coordination 3 The access problem: one-stop-shops, multidimensional assessment and guidance France – Greece – Italy

15. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The case of France: Local Information and Gerontological Co-ordination Centres (CLIC)  Type of coordination:  single point of entry to social and medical care in the community  Methods: 1)welcoming, informing, advising and supporting 2)assessing needs, compiling personalised care plans 3)implementing, monitoring and adapting care plans  A small team (case manager, assistant, secretary) to promote a mutually shared gerontological culture with all stakeholders in the community

16. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Pathways to integrated care 4 The (almost) consolidated direct service model: 24-hours community care centre Denmark Hospital  General Practi- tioner Nur- sing Home Care Short term Care Home Help Other Services, Housing, etc.  Residential Care  Day Care

17. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The case of Skævinge (Denmark): The Health Centre ‘Bauneparken’  Type of integration:  24-hour integrated health and social care  consolidated direct service model  single, public provider  Methods:  person-centred integration of cure, care and social inclusion of older citizens in the municipality  a single point of contact for potential users of health and social/personal care in the municipality  case-management  concepts of self-care and prevention

18. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 The case of Skævinge (Denmark): The Health Centre ‘Bauneparken’  Results:  No waiting time for apartments or services  Preventative efforts have entailed a surplus of capacity used to establish more specialised services (intermediate care)  Number of days in hospitals for all citizens reduced by 30-40%  No citizen has to wait for discharge in hospital  The municipality’s use of and expenditure to national health insurance is below the average

19. THE EUROPEAN COMMISSION THE 5TH FRAMEWORK PROGRAMME QUALITY OF LIFE AND MANAGEMENT OF LIVING RESOURCES Key Action :: The Ageing Population and Disabilities Contract No. QLK6-CT-2002-00227 Thank you for your interest! For further information, please see: www.euro.centre.org/procare