1. The Aged Care System in Denmark Dr A Andrew Fleming Southern Cross Care (NSW & ACT) Inc University of Western Sydney

4. Denmark – Some Facts Population of 5.3 million 13% over 65 years Demographic ageing –By 2025 over 65s will grow by one third High labour force participation rates –76.3% persons 16 to 66 years working –79.1% of women work

5. Denmark – Some Facts In 2004 population 67+ = 700,00 500, 000 able to manage at home 175,000 receive public home help 23,000 live in nursing ‘homes’

6. Copenhagen – Some Facts Population of 500,000 12.1% over 65 years Home and Care Service –95,000 visits in 17,000 homes Housing for older people –4700 purpose-built ‘elder homes’ –4900 nursing ‘home’ places

7. Social Policy in Denmark Welfare State ‘Cradle to the grave’ Universal benefits and services –Financed through general taxes –Centralised pension –Decentralised system of care services Challenges of demographic ageing

8. Welfare State Welfare Society Legislate and allocate funds OS – umbrella organisation promoting the welfare of older Danes: - influence policy on older persons - educate the community, e.g. dementia - development of personal skills and knowledge

9. Welfare State Welfare Society Develop voluntary social work - NB volunteerism is relatively new for adult Danes - target lonely and isolated older people - ‘fit’ elderly helping ‘frail’ elderly, e.g.‘visiting friends’ program Using technology such as the internet and ‘Webcasts’

10. Local Government Responsibilities 14 counties –Hospitals –Medical care outside hospitals –Services for disabled and abusers 275 municipalities –Care for dependent older persons and day care facilities –Social security schemes, e.g. old age pension, sickness benefits, child allowance

11. Intrinsic Value of Older People Local senior citizens’ council (4 years) Complaints Board Platform for communication between older people and local council All matters relevant to older people must be referred, e.g. reports from quality visits to nursing homes

12. Community & Residential Care Well developed integration and interdependence Linkages provide for ‘seamless’ transitions Single point of entry Less choice for older Danes but this is changing

13. Community Care Services Copenhagen (67+ = 53, 930) Home nursing and home help – 16,800 clients 95,000 visits per week Elderly homes 81 per 1000 Nursing homes 114 per 1000

14. Community Care Example Mrs W – 76 years, widow, 4 children, knee and back problems Ageing in place – up to 40 hours of home help Choice of supplier Home help starts immediately Community nursing generally through GP

15. Community Care Example Day Care Centre – 6 month contract Physical training provided free Subsidised dental treatment, transport and food Nursing ‘homes’ have some rehab ‘beds’ –Temporary rehab – home modifications Nursing homes – 24 hour care required Persons given choice of nursing home

16. Health promotion Preventive house calls Danes 75+ offered a house call twice a year Aims: –Monitor health and well-being –Advice and support regarding resources and services –Maintain function and quality of life

17. Fall Prevention In Copenhagen ‘Healthy city’ project from 1994 – 2003 Health targets of: - legal right to prevention - increase average human life - decrease social inequalities - improve health and quality of life - include general health in politics of local authority

18. Fall Prevention In Copenhagen Provide hip protectors free of charge Three pairs of ‘Safehip’ protectors distributed after: - professional assessment - a successful one week trial which includes a diary of pros and cons - ‘Safehip’ to be worn a minimum of 8 hours/day

19. Fall Prevention In Copenhagen Outcomes: - acceptance rate is approximately 33% - 35% reduction in hospital discharges - 19% reduction in incidence per 100,000 65+ - significant reduction in health spending - NB hip protectors a supplement NOT a replacement

20. Housing for Older People Majority live in ordinary housing Only 4 – 5% in purpose-built or nursing home accommodation Need is the primary determinant of service Services delivered in: –Own home, ‘elder’ home or nursing ‘home’

21. ‘Elder home’ –Independent living complex with adaptive housing Nursing ‘home’ –‘Apartments’ with one (50 sqm) or two rooms (65 sqm) with a kitchenette and ensuite bathroom –Communal areas, gymnasium, open café, day centre Housing for Older People

22. Residents in Nursing Homes Free nursing services Purchase hotel services, e.g. domestic, food package Open café and day centre where people from general community attend for meals and/or services Gymnasium for residents and staff

23. Funding and Resources Frail older people equivalent of 0.95 per staff member per day Persons with dementia is 1.66 Activity centres is 0.433 Full-time physiotherapy staff –88 bed RCF has 50 hours of physiotherapy over 7 days –Resident participation rate of 60%

24. Quality Assurance All municipalities must issue quality standards Monitor at least annually: –Nursing homes can expect 3 visits, 1 of which is short notice Currently developing national standards –Exploring models as per Canada and Australia

25. Lessons for Us Well-established focus and resourcing of wellness and health promotion Intrinsic value of older people Integration of community and residential care – ease of navigation for consumers Increased funding of persons with dementia Flexible and adaptive housing at all levels

26. Lessons From Us Choice of providers for older Australians Dementia care and services Australian Aged Care Standards