Long-term care in Luxembourg universal funding system

Transcription

1 Facts about elderly people and long-term care in Luxembourg Alain Koch Stëftung Hëllef Doheem Christine Weisgerber Inspection générale de la sécurité sociale Projections of the elderly population Demographic projections show that Luxembourg will by confronted by an ageing population, due to an increase of the life expectancy and a decrease of the fertility rate and the migration. In, life expectancy at birth in Luxembourg was 77.8 years for men and 8.9 years for women. The demographic projections show that in 6, men s life expectancy is 84.9 years and women s life expectancy is 89.5 years. In, only 4% of the insured population in Luxembourg is aged 65 years or older and.5% is aged 85 or older. Demographic projections show that, until 6, the percentage of the group 65+ will nearly double and the percentage of the group 85+ will be multiplied by 4. So we can assume that the number of elderly people needing long-term care will increase, even if the number of healthy years increases life expectancy at birth women 8,9 84,4 85,8 87, 88, 89,5 men 77,8 79,4 8,9 8, 8,6 84,9 persons persons 65+ / total population, % 4, 5,8 9,6, 5, 6,4 women 65+ / persons 65+, % 57,4 54,6 5, 5, 5,6 54, persons 85+/ total poluation, %,5,,4,4 5, 6, Long-term care in Luxembourg universal funding system Since 998, long-term care insurance is a branch of compulsory Social Security. Any person in need of the assistance of another person, be it a professional or a close relation, for carrying out the activities of daily living is entitled to long-term care insurance. A need for assistance has to persist for at least six months and has to be important (more than.5 hours per week). Entitlement to benefit is not means-tested and there is no waiting period. Estimation made by EUROSTAT Europop.

2 A dependent person is entitled to assistance for activities of daily living (personal hygiene, nutrition or mobility) and, depending on the level of dependency, help with household tasks, support activities, and/or advices for the dependent person or his informal carer. For a home-based dependent person, the long-term care insurance will pay for the help and care given by a care network (a professional service which has a contract with LTC insurance and provides assistance and care to the home-based dependent person) or by a semi-stationary centre (a centre to which dependent people can go during the day or night and during the time that they are at the centre, the dependent people receive all the help and care which is necessary). The long-term care insurance acknowledges the assistance provided by an informal carer (anyone who is not linked to a care network). If the informal carer doesn t benefit from a personal pension, the long-term care insurance also pays his contribution to pension insurance. For a dependent person within a care institution, the long-term care insurance pays for the assistance and the care given by this institution. Even if a person is not dependent, but needs technical assistance (e.g. wheelchair, walking frame) or a modification of the home (e.g. installation of a shower on one level), the long-term care insurance covers those expenditures. Luxembourg doesn t have any experience in developing technology that can assist elderly people or their relatives in everyday life, but supports the use of those technology as described in the previous paragraph. The Evaluation and Orientation Unit elaborates the care plan containing the services the dependent person is entitled to, in accordance to his level of dependency. All those services are covered entirely by the long-term care insurance. Active and retired persons pay a special contribution of.4% of all their incomes (wages, revenue, pensions, income from an inheritance). This is supplemented by a State contribution (actually 4 million Euros) as well as by a contribution from the electricity sector. Luxembourg, like Sweden, is searching for new possibilities to reduce the average expenditure per dependent person and increase the contributions because recent estimations on long-term sustainability foresee an annual growth of,6% of long-term care recipients and of,6% of longterm care expenditure until. To ensure financial sustainability at short term, the government s contribution is adjusted. A revision of the law is planned from onwards in order to respond to the demographic evolution and the changing needs of the dependent population. Health care and the impact of the reform of for the LTC sector Luxembourg has an high standard of compulsory state-funded healthcare. Medical staff is well trained. Free and subsidized healthcare is available to all citizens and registered long-term residents. Private healthcare is also available in the country. All citizens are entitled by law to equal access to healthcare and they have the right to choose their doctor, specialist and hospital. 4 Mio EUR in, i.e.% of total LTC expenditure (allocation to working capital included), to 5% of total LTC expenditure (allocation to working capital included).

3 State healthcare covers the majority of treatment provided by general physicians and specialists as well as laboratory tests, pregnancy, childbirth, rehabilitation, prescriptions, and hospitalization. Like in all the other EU countries, Health care is changing in Luxembourg. Ageing populations, new therapeutic possibilities and rising expectations have made the provision of health care much more complex than in the past. Luxembourg is trying to respond to this challenge, introducing new ways of delivering health care. At the heart of these changes are the health professionals. Continuing professional and vocational education is organised through the ministry for education and vocational training. The key objective of these educational programs is to enable people with professional qualifications to remain aware of the economical needs of their sector and keep up to date with technological advances in their field. Demographic change in Luxembourg is an economic challenge for the entire health sector. In 9, the health and social work sector represents 7.9% of the domestic employment and this percentage is likely to increase in the next years with regard to the demographic projections. A health care reform in Luxembourg was realized in. The strategy is based upon improvement healthcare quality and reduction in need and demand for medical services. The reform previews changes on different levels like providing resources, training and network opportunities in healthcare, health promotion focused on increased personal responsibility for health-related actions. The principal goals are: Improving long-term health-related actions; Better equity in use of health services; Better quality of care; Increasing Patient safety and satisfaction; Improving organisational efficiencies; Improving technical efficiency; Improving continuity of care and patient centric health services through the use of innovative IT solutions; Fostering long-term financial sustainability reduce health care costs. The challenges are to create links, partnerships and interdisciplinary communication between several Health Care and Socially Related Organisations in Luxembourg: Ministries and Administrations; Hospitals; Luxembourg in figures STATEC.

4 Retirement and Nursing Homes; Laboratories; Portals; Insurances and Social Security; Institutional and Professional Associations and Organisations; Other Associations and Organisations. The Luxembourg government has adopted a national e-health plan, which recommends the creation of a networked platform supporting different applications for the exchanging and sharing of health related data. esante is a programme which will support multiple projects; the first two involving the transmission of radiology reports and images and the improved exchange of laboratory analysis results. esante framework will utilize a patient anonymisation infrastructure which will be designed to insure patient data protection. Experiences and innovations in the LTC fieldwork by Stëftung Hëllef Doheem In,.76 persons were covered by the long-term care insurance persons (6% female) get care at home and.87 persons (77% female) get care in an institution. Among the persons getting care at home, only 9% were aged 8 years or older. Among the persons getting care in an institution, 77% were aged 8 years or older. 4 The Stëftung Hëllef Doheem (SHD) is the biggest homecare provider in Luxembourg (in 9, 55% of the homecare provider workforce (fulltime equivalent) is employed by SHD). SHD takes not only care of persons taken in charge by the LTC insurance, but provides also health services. The following chart gives information about the number of persons taken in charge by SDH, per gender and age. Note that the chart takes into account not only the persons covered by LTC insurance, but all the clients of SHD. 4 Source: Rapport général sur la sécurité sociale Inspection générale de la sécurité sociale.

5 Men > 55 ans 5-55 ans 46-5 ans 4-45 ans 6-4 ans -5 ans 5 - ans < 5 ans The services of SDH are provided essentially by women. Only % of the workforce of SHD is male. The share of older workers (5+) represents only 4% of the total workforce of SHD. As a small country, Luxembourg faces a challenge in responding to the growing demand for doctors and nurses over the next years. Since several decades Luxembourg is characterized by significant international migration of health workers, across Germany, Belgium, France and other countries in the EU area.

6 Share of foreign nationality workers (SHD) German workers.57% French workers.87% Portuguese workers.% Belgian workers 6.% Italian workers.6% Dutch workers.75% Other*.98% Luxembourgish workers 44.6% In,SHD employed 7 different nationalities. 7% of foreign nationality workers are living in Luxembourg. 8% of the workers are non-residential workers, 6% are living in Luxembourg. 5 Actually, the recruitment of new LTC workers is not too complicated. In Luxembourg, the wages are above the wages in France, Germany and Belgium, which allows to recruit nonresistent workers. Older Luxembourgish persons speak often only Luxembourgish and a little German and/or French, which may result sometimes in communication problems between clients and workers, because not every foreign worker speaks Luxembourgish. Some of those communications problems may disappear in the future. Several Care Providers, including SHD, are working on implementation of a software solution for the managing of care data. The software solution has to deliver a multi-user application with customizable profiles (nurses, help-nurses, administrators) combined with a multi-lingual user interface. This claims for the use of a standardized nursing language for documentation of nursing care. This should be vital to the nursing profession and to the bedside/direct care nurse. The potential benefits of the software solution include: better communication among nurses and other health care providers; increased visibility of nursing interventions; improved patient care; enhanced data collection to evaluate nursing care outcomes; greater adherence to standards of care; 5 Information concerning the educational levels and the part-time employment can be found in the appendix.

7 and facilitated assessment of nursing competency. In order to use the software solution correctly, the health workforce has to acquire a new range of skills. Therefore, training programs have to be put in place. The SDH is working on a diabetes prevention and care plan. The project adopts and implements continuing professional and vocational education. The goal of this project is to prevent and control diabetes and diabetes related complications. It expands the workforce (including the informal carers) able to address the burden of diabetes by supporting different levels like diabetes selfcare and prevention, education and pre-diabetes care, quality improvement in diabetes clinical care. These elements work together synergistically to constitute a comprehensive system approach to diabetes prevention and control.

8 LUXEMBOURG Appendix Whole and part-time employment (Foundation Stëftung Hëllef Doheem ) Weekly tasks.. Oc c upa t i o na l t h e r a pi st s, Executive director s Employment Senior managers Managers A d minist ra t o r s Auxiliary nurses Nurses Ps ycho lo g i st s, ed ucat o rs phy si ot he r a p i st s, so c i a l wor k e r s, Healthcare Assistant Housekeepers Total en % di e t i c i a ns, Total Variation // - psy c h om ot or sp e c i a l i st < hours - hours hours 7-9 hours 4 hours 8 54 Total weekly tasks lower to hrs.75%.75% % weekly tasks lower or equal to hrs.7%.8% 68-5.% weekly tasks lower or equal to hrs 5.45% 9.6% 9.% weekly tasks lower or equal to 9 hrs 4.6% 6.% % % 6.67% 6 4.8% % '564.6% 67 weekly tasks of 4 hrs 58 '77 Weekly tasks st october % 9% 4 8% 7% 54 % Executive directors - October Senior managers Managers Peer Review Psychologists, educators Occupational therapists, physiotherapists, social workers, dieticians, psychomotor specialist 6 Administrators Nurses Auxiliary nurses -9 hours - hours hours - hours % % % % 8 6 6% 5% 96 7 < hours 94 7 HealthcareAssistant Housekeepers Closing the Gap in search for ways to deal with expanding care needs and limited resources, Sweden 8

9 Education levels (Foundation Stëftung Hëllef Doheem ) Occupational therapists, physiotherapists, social workers, dieticians, psychomotor specialist Psychologists, educators Nurses Auxiliary nurses Healthcare assistants Staff members and executive director board Administrators Housekeepers.9%.% 4.4% 5.9% 4.4% 7.6% 6.7%.44% Occupational therapists, physiotherapists, social workers, dieticians, psychomotor specialist Psychologists, educators Nurses Auxiliary nurses Healthcare assistants Staff members and executive director board - October Peer Review Closing the Gap in search for ways to deal with expanding care needs and limited resources, Sweden 9