A Nordic Model for Aged Care. Professor Tine Rostgaard, VIVE, Denmark

Transcription

1 A Nordic Model for Aged Care Professor Tine Rostgaard, VIVE, Denmark October 16, 2017

2 Overview Main principles of Nordic age care model, with Denmark as a case of illustration A dignified old age: Ageing in place, continuity and normalisation Drivers for change and four responses: privatisation, marketisation, reablement and welfare technology Tine Rostgaard VIVE

3 Nordic countries: Iceland, Norway, Finland, Sweden and Denmark Tine Rostgaard VIVE

4 From the countries that brought you IKEA, Lego and Mumin fairytales: the building blocks to create your own Nordic aged care system NORDIC AGED CARE: Thanks to Jon Kvist! 4

5 Nordic social care model Public service model : Universalism Public, formal and de-centralised approach (organisation, regulation and financing), although increasingly market based Service intensive Tax-based; affordable; free home care High coverage and take-up rate, no stigma associated National assesment system and one entry High quality of care services: regulation, professionalised, trained and relatively well paid staff Enables gender equality and the facilitation of the dual earner-dual carer model Broad public support - in DK 60% of local votes depend on whether parties support social care for older people 5

6 Proportion 65+ recieving care at home/institution, 2014 or latest available year 6

7 Public expenditure on aged care, as % of GDP, 2014 or latest year Australia: less than 1% 7

8 EU Active Ageing Index: employment, social participation and independent living 8

9 The case of Denmark: A dignified old age Early implementation of de-institutionalisation in 1970s: Policy of As long as possible in own home, and subsequent heavy investment in home care National Commission on Ageing in 1980: Promoting independence of care with principle of help-to self-help as well as principles of continuity and normalization From traditional hospital-like nursing home institutions to modern nursing home appartments, plejeboliger, from Tenant principle 9

10 Terrace Bedroom Example of nursing home appartment Living room/ Kitchen Bath 10

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12 The former prime minister Anker Jørgensen visiting - and later moving into - a public nursing home 12

13 Drivers for change and four responses With ageing populations, shrinking labour force, informed consumers and a relatively costly aged care system in place, need for new and innovative solutions! Four responses: - Privatisation - Marketisation - Reablement - Welfare technology 13

14 1. Privatisation and the non-profit sector Interest in the non-profit sector as alternative professional provider in aged care, in particular nursing homes Interest in activating OPs. A potential resource in an ageing society with a retiring work force. 25 % of 65+ volunteers in DK. Especially active within activities related to social and health care. Prevention of social exclusion Interest in non-profit actors as providers of supplementary welfare services 14

15 Cycling Without Age, letting older people feel the wind in their hair again. Non-profit movement started in Denmark in 2012 by Ole Kassow. Ole wanted to help frail OPs getting back on their bicycles, but he had to find a solution to their limited mobility. The answer was a rickshaw and he started offering free bike rides to the local nursing home residents. Cycling Without Age is now operating across 28 countries including Australia, offering OPs both in nursing homes and in their own homes the opportunity to get out and about. Also good results with OPs with minor dementia, as reminiscence therapy For more info, visit Stand No 127 & 128

16 2. Marketisation: A public service model with modifications Mandatory Free choice of public/private home care provider since Same assessment and financing system; and still no fees. Provider transparency Private, cleaning Private, total Private, personal care and cleaning Home help % % of all users of home care use a forprofit provider today. 15% of total market share. Mainly cleaning and mainly in larger cities. Possibility for topping-up Private, personal care Outcomes: OPs satisfied with both providers and with choice option, but few exits Substantial no. of bankruptcies; costly for LAs, as well as for users and care workers Working conditions poorer in for-profit sector 16

17 3. Reablement: Fundamental change to approach in home care provision Reablement is an individualised care provision supporting independant living: - Focus is to help people with poor physical or mental health to accommodate their illness, by learning or relearning the skills necessary for daily living - Goal-oriented (outcome) rather than merely input and output oriented - Based on what matters to the older person, not care staff Overall aim to improve quality of life and contain Aged care costs Broadly implemented in home care across different Aged care regimes: - Part of national legislation in Denmark, locally implemented in Scotland, Norway, the Netherlands, Australia, England and New Zealand 17

18 From passive to active care: Doing with rather than Doing for/to 18

19 Typical reablement intervention in Denmark Short-term duration of 12 weeks Continuous assessment of needs and services as well as goal-setting together with OP Daily visits from social care worker providing assistance with and supporting OP in performing IADL and ADL tasks Supported by assistive devices Physical training important, especially in-house, e.g. climbing stairs Multi-disciplinary approach: Physio/occupational therapists supervise the social care worker and visits OP when needed After intervention, the municipality assess whether the OP is fully or partially self-reliant and if further assistance from home care services is needed Outcomes: Cost-effectiveness QoL, working conditions 19

20 4. Welfare technology Means to ensure independent living and thus further quality of life Assumption about more cost-effective ways of providing welfare Contribution to a better work environment for the care workers Solutions for growth and export opportunities 20

21 RotoBed Rotobed is a fully automated bed that can move its user from a lying position to an exit position in about 40 seconds, providing its user with independence. MELVIN@ For more info on PDC Plan, RotoBed and Dosesystem, visit Stand No 127 & 128 Assistive device with magnets for pulling trousers up/down PDC plan PDC Plan is a comprehensive workforce management system designed to meet the complex needs of health workforce. Dosesystem The Dose System gives audible and visible reminders to the client to take their medication and/or other things like the need to hydrate or eat a meal before taking medication. If the client does not take their medication, a nurse is alerted in real time on an app on their mobile phone.

22 Thank you for your attention, Gold Coast! 22