1. Danish Elderly Care System and the Approach of Preventive Interventions
International Conference
Oulu Vocational College; Social and Health Care Unit
Developing the Care of Older People
Tine Rostgaard, senior researcher, SFI – the Danish National Centre for Social Research
Titel og undertitel står med store bogstaver (Versaler) og skal holdes indenfor de to vandrette grå linjer.
Titlen kan stå i farve, eller der kan vælges en baggrundsfarve fra en af farvepaletterne til feltet mellem de to vandrette linjer.

2. The Development of the Danish Care for the Elderly
Overview
The Danish Context
The Development of the Danish Care for the Elderly
Caring for the Elderly at the Turn of the Millenium 
Preventive Efforts
Where are We Heading?
Tine Rostgaard

3. The Danish context 40.000 square kilometres 98 municipalities
5 countries
5.5 million people
Tine Rostgaard

4. Most people work (72% of women, 81 % of men)
Most people work (72% of women, 81 % of men). One in three women work part-time (In Finland, 79% of men and 76 % 0f women)
Like other Nordic countries, Denmark spends considerable part of GDP on social expenditure (1/3)
Old age pension is available to all citizens from the age of 65 years.
Average life span is for women 80 years, and 75 years for men. (FIN: 82 women and 75 years men)
Fertility rate is 1.74 children per woman (same as in Finland; EU average 1.45)
Tine Rostgaard

5. Age dependency ratio, 65+ as % of 15-64 year olds, 2000
Tine Rostgaard

6. North Marked State West East Civil society South (Abrahamson, 1992)
Tine Rostgaard

7. What characterises Nordic care for the elderly?
Municipal responsibility for organisation and provision - One access for all benefits
Tax finansing (mainly: free services in DK, max payment in N and S)
Politically administered by Ministries of Social Affairs, not Health
High coverage
High quality: professionalised, regulated
Tine Rostgaard

8. Care situation in Denmark - overview
Public responsibility to organise, finance and provide care
Care mainly provided in a formal setting, care workers certified and regulated
Informal care by spouse/partner, but not often by other relatives
No cash for care schemes, apart from care for terminally ill
High quality standards – assuming most care staff with education in care
Tine Rostgaard

9. Who provides help for you, % elderly 65+
Tine Rostgaard

10. No of elderly 65+ living with their children
Tine Rostgaard

11. A history of Danish care for the elderly
De-institutionalisation 
De-centralisation
From residential care to nursing care
Welfare state crisis – endelessly more resources will not solve problems 
Tine Rostgaard

12. Elderly Commission - autonomy, continuity and coordination
From residential care to residential housing
No more building of traditional nursing homes
One stop offices
Tine Rostgaard

13. - participation and responsibility - flexibility - early intervention
Free home help
Preventive efforts
New Service Act
-      participation and responsibility
-  flexibility
- early intervention
-      ’we can all contribute’
Individualisation of care needs, but also standardisation, Common language
Integrated services
Tine Rostgaard

14. Free choice of home care provider - From client to customer
After the millenium
Free choice of home care provider - From client to customer
Purchaser-provider model
Trails with cash for care
Interest in civil society ressources
Evidence based methods – new assesment procedure
Tine Rostgaard

15. Main social services for the elderly
Home help – free choice and free of charge
Nursing home – as long as possible in own home, payment of rent, and use of service (choice of different items), max. payment
Service housing
Transport scheme
Adaptation of the home
Meals on wheels
Carer’s allowance
Day centres
Preventive visits
Senior citizens' council and complaints boards
Tine Rostgaard

16. Distribution of expenditure for elderly people, services
Tine Rostgaard

17. Home help, 65+, Scandinavian countries, 1982-2002.
Tine Rostgaard

18. % of population 65 with home help, various countries
Anm.: Data for DEU, UK og NLD er for år 2000 og stammer fra Rostgaard (2004b), mens de øvrige data er fra Nordisk Socialstatistisk Komite (2004). For Danmark er andelen op-gjort for personer på 67 år og derover.Kilde:Nordisk Socialstatistisk Komite (2004) og Rostgaard (2004b).
Tine Rostgaard

19. Share of elderly 65+ in nursing home or sheltered housing, 2000.
Tine Rostgaard

20. Satisfaction with social and health services, EU, elderly
Tine Rostgaard

21. Preventive home visits
1996 law on Preventive home visits
Elderly 75+
Living at home (municipalities can decide to include residents in nursing home facilities)
Two annual visits
A structured, holistic discussion of general well-being, social networks, housing, finances, health, functional ability
Concentrated especially on how the elderly masters daily tasks, rather than focussing on illnesses and diseases.
Municipality must offer services if so needed, and decides which staff perform the visits – most often home nurses
Tine Rostgaard

22. Take up
Voluntary visits, in 1998 four out of ten declined offer of first visit, and fewer declined offer of second visit.
Elderly 80+ more often declined.
Related to whether they should be active – in municipalities where the elderly should ask for visit, fewer visits
Tine Rostgaard

23. Evidence Several randomized control intervention studies:
General findings: elderly appreciate the visits; result in increase in use of home services, fall in mortality and need for nursing home.
Some show an increase in functional ability, lower mortality and lower admission rate to hospital and nursing homes.
(eg Vass et al, 2002)
Still need for intevention studies that can show who best benefit from the visits, which staff groups should be involved and how staff members should co-operate.
Evidence suggests that the more intensive the intervention, the more cost-efficient
Tine Rostgaard

24. Where to in the future? Challanges: Ageing Fewer labour market active
Increased need for care
Differentiation of care needs
Recruitment and retainment of care staff
Tine Rostgaard

25. Solutions? Prevention Better management of ressources
Better overview of assesment for care
More welfare mix
Targeting the most needy
More user payment
Tine Rostgaard

26. Thank you!
Tine Rostgaard