1. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 1 USA-BE Same problems, different solutions The growth of aging populations : a challenge for health Systems Caring for the elderly : Elements of Policy making in Belgium Mr Christiaan Decoster Director-General Directorate-General Organisation of health care establishments

2. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 2 USA-BE Agenda of the workshop on March 21,2006 1.Future needs for acute hospitals Prof Cannoodt and Prof Rossi Discussion 2.Facilities for elderly people Muriel Quinet Discussion

3. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 3 USA-BE 1. Future needs for acute hospitals in Belgium. 1.1. Objective : - Needs for general hospitals in 2005 - Projections 2015 1.2. Needs 2005 Conclusion : the existing hospital-beds capacity exceeds national needs and, as a result, there is an excessive supply at the moment for C, D, M and E- beds, and a shortage for G- beds.

4. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 4 USA-BE 1.3. Projections 2015. The conclusion is that there is no reason to suppose that the total number of acute hospital-beds should be increased in the future. On the contrary, the use of acute hospital-care could be slightly lower in 2015 than the forecasts for 2005.

5. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 5 USA-BE 1.4. Concrete policy initiatives. -Reconversion of C-, D-, H- beds into G + RVT (= residential and care homes) + alternative supply (day hospital + short stay). -We have to draw up a plan for geriatry, including the forms of cooperation between establishments, adapted home-care, education, etc.

6. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 6 Discussion needs for acute hospital care - Can we divorce the analysis of acute bed needs from the needs related to long-term ill persons? - Paying attention to specific illnesses and outcomes - Updating needs analysis every two years - Taking into account pecific problems of elderly people, e.g. a fall can lead to double length of stay - Is DRG an appropriate tool to measure needs? It is difficult to interpret -

7. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 7 Discussion needs for acute hospital care -Do the conclusions coincide with the international comparisons stating that Belgium has too much beds and a too long length of stay ? -A lower bed capacity is possible, but then it has to be used for other purposes -A lower bed capacity goes hand in hand with investing in staff skills -The work load increase remains limited, but it says nothing about bed needs

8. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 8 USA-BE 2. Facilities for elderly people The first strategic approach dedicated to the coordination of health care efforts between all responsible governments with emphasis on promotion of care at home and the possiblity of upgrading traditional resident care by protocol 3. Protocol 3, is such a joint policy statement providing a number of common goals while respecting the diversity of the Communities and te Regions.

9. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 9 USA-BE Among these goals : * Implementing a coordinated, coherent, preventive and curative policy. * Giving more support to the family members. * Raising public awareness and detecting all forms of elderly people. * Identifying the subjective and objective care needs. * Integrating care in a long-term policy. * Developing the Integrated Home Care Services.

10. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 10 USA-BE The Federal State puts a € 174 million budget at the disposal of the Communities and the Regions, spread over a six-year period. The second strategic approach is dedicated to the coordination of an integrated care network between all different health care structures and professionals as is aimed at in the geriatric care programme.

11. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 11 USA-BE 5 elements : -The geriatric service (G index) -The geriatric consultation -The geriatric day hospital -The internal liaison function -The external liaison function.

12. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 12 USA-BE The third and last strategic approach is dedicated to the development and promotion of a common tool for adequate evaluation of the need of care for each individual patient as well as the support of the multidisciplinary approach and coordination of care. The outcome of a study showed that the RAI/MDS-tool was the best instrument to control the quality of the care and to stimulate the collaboration within the care-team that assists the patient.

13. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 13 USA-BE The federal government will initiate local pilot- projects to test the use of the RAI/MDS-tool in the geriatric day-hospitals, in the nursing-homes and in the day care centers as well as in the integrated home care services.

14. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 14 Discussion facilities for elderly -Why not allocate some of the additional funds to best practices? -Quality is important but, first, we must have the personnel -There are still shortages in geriatric services : physiotherapy, occupational therapy, psychologists, improvable quality of food -We have to invest in training -There is a need for more research in Belgium

15. FOD VOLKSGEZONDHEID, VEILIGHEID VAN DE VOEDSELKETEN EN LEEFMILIEU Friday, 01 August 2014 15 Discussion facilities for elderly -We should follow a twin-track approach : a) we must invest more in primary care b) invest in personnel working with elderly people -As personnel skills are not sufficient, they often do not identify problems -Function differentiation is needed : some skilled people + nursing personnel -We should work on an interdisciplinary basis with care pathways -No money for additional beds, but for best practices