22nd European Social Services Conference – Rome, 7-9 July 2014

Social and healthcare integration

Lazio Regional Authority strategyto support people with Alzheimer’s

Workshop presented by:Regione Lazio, Italia

Diapositiva 2 di 16

€ 160 billion: the total estimated cost of dementia disorders in EU27 in 2008 56% of which were costs of informal (unpaid) care

Source: Anders Wimo, 2008 – in Alzheimer Europe

7.3 million people with dementia in EU27numbers expected to at least double by 2040

€ 22.000 per person per year: the average cost with dementia in EU27

Alzheimer’s in EuropeCONTEXT

22nd European Social Services Conference – Rome, 7-9 July 2014

Diapositiva 3 di 16

In Italy, more than 1 million people are affected by dementia

600.000 affected by Alzheimer's disease Total cost of dementia is estimated beyond 29 billions € The cost per demented is about 28.600 €

Direct costs are 15% of the total,i.e. 4.500 € per demented

Informal care costs are 85% of total cost, i.e. 24.100 € per dementedSource: Alzheimer Europe, 2008

Source: Alzheimer Italia, 2011 e Alzheimer Europe, 2008

Alzheimer’s in ItalyCONTEXT

Sweden

Italy0

20406080

100

Informal care costDirect cost

22nd European Social Services Conference – Rome, 7-9 July 2014

Diapositiva 4 di 16

Total inhabitants of Lazio: 5.500.000 Inhabitants aged 65+: 1.100.000 Estimated dementia incidence: 71.000

(6% of population aged 65+) Estimated Alzheimer’s incidence: 40.000 (55% of all

dementias) Actual patients in care affected by dementia: 36.000

Direct costs Medical exams, hospital stays, medicines Formal care: home care, day care centers Nursing homes Financial support to demented and

families: disability pensions, vouchers for assistance, etc.

Direct costs Direct share of health and social service costs Costs for assistance personnel and aid tools

Informal care costs Loss of productivity (for both demented and family

members) Psychological and physical stress and pain for

informal caregivers

Costs incurred by families (80%) Costs incurred by public sector (20%)

Alzheimer’s in LazioCONTEXT

22nd European Social Services Conference – Rome, 7-9 July 2014

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The 2013 World Report on Alzheimer’s outlines the following main Recommendations:

Governments around the world should make dementia a priority by implementing national plans…

Monitor the quality of dementia care in all settings

Autonomy and choice should be promoted at all stages of the dementia journey

Health and social care systems should be better integrated Need to train caregivers and to provide them with financial reward Quality of life at home can be as good, and costs are comparable

The quality of care in care homes should be monitored through the quality of life and satisfaction of their residents

World Report on Alzheimer’s 2013CONTEXT

22nd European Social Services Conference – Rome, 7-9 July 2014

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L. 104/1992 – National law on assistance, social inclusion and rights of the disabled

L.R. 6/2012 – Regional Plan for people affected by Alzheimer-Perusini’s and other dementias

National level Lazio Region

A national plan on Alzheimer’s is to be approved

It defines the service network, access procedures, some governance tools such as the Dementias Information System and the Dementias Regional Register.

Services are designed as follows:• Centres for diagnosis and medical treatment• Semi-residential/Residential services (both health and social care)• Home care• Financial support to families and to volunteering associations• Training courses for caregivers + information for demented and

families• Register and Information system

Regulatory framework in ItalyCONTEXT

22nd European Social Services Conference – Rome, 7-9 July 2014

Objectives To foster a multidimensional approach to

Alzheimer's disease To realize and integrated network of health

and social services for demented and their families

To even out the services offer on the whole of regional territory

National and regional resources in 2012Fund for disability (non self sufficient persons, LSA, dementias, etc.) € 119.600.000,00

Specific fund for Alzheimer's € 7.000.000,00 (DGR 504/2012)

Overview on the Regional PlanREGIONAL POLICY

€ 7.000.000,00

National resources

Regional resources

22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 7 di 16

1. New social units coinciding with health units

2. Integrated health-and-social actions

3. Bottom up process in service design and delivery

4. Service standardization

5. Online monitoring and financial reporting

Outstanding featuresREGIONAL POLICY

22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 8 di 16

Health units (ASL)

Health Social

8 new social units coinciding with health units and formed by social districts

Social Districts and new social scope units

New social unitsREGIONAL POLICY

22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 9 di 16

Health Social

• New social services units: coinciding with health units

• Shared design of Individual Assistance plan (PAI)

• Shared methodology between social services and health sector

• Shared services delivery with health sector

Social & healthcare integrationREGIONAL POLICY

22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 10 di 16

Residential / semi-residential Day-care centres and short-term residen-tial

Direct and indirect home-care

Information and training Alzheimer's Café, self-mutual help, caregivers' training

53

41

6

Resources destinationREGIONAL POLICY

22nd European Social Services Conference – Rome, 7-9 July 2014 Diapositiva 11 di 16

Diapositiva 12 di 1622nd European Social Services Conference – Rome, 7-9 July 2014

Outcome

Day care centres for Alzheimer's

Short term residential service

Service offer in 2012: 19 day care centres with 400 placesIncrease of service offer in 2014: 8 new day care centres and 140 places

Criticalities

High start up and management costs

Uncertainty about level of financial resources through different years

Service offer in 2012: 120 short term residential placesIncrease of service offer in 2014: 30 short term residential places

Territorial diversity in service offer: 17 day care centres in Rome

Residential & semiRESULTS AND PERFORMANCE

Diapositiva 13 di 1622nd European Social Services Conference – Rome, 7-9 July 2014

Outcome

Direct and indirect home-care

Current offer: 8.500 users

Increase of:

500 new users who will receive home-care

Uneven service supply:

from six months to one year

from 12 to 44 hours per month

from 100 to 800 € per month

Criticalities

Home care is the most requested service innon-metropolitan areas

Home-careRESULTS AND PERFORMANCE

Diapositiva 14 di 1622nd European Social Services Conference – Rome, 7-9 July 2014

Criticalities

Information to families Self-mutual help of informal care-giversAlzheimer CafèCare-givers training

Outcome

Uneven use of financial resources and kind of service delivered

New places for socialization (Alzheimer Café)

Development of family networks

Training for 130 formal and informal caregiversCare-givers often get little Alzheimer’s specific training

Information & trainingRESULTS AND PERFORMANCE

Diapositiva 15 di 1622nd European Social Services Conference – Rome, 7-9 July 2014

Guidelines in service supplying

Online application for monitoring and financial reporting

Widening of type and quantity of supplyed services

Summing up… on the positive side

ConclusionsRESULTS AND PERFORMANCE

Diapositiva 16 di 1622nd European Social Services Conference – Rome, 7-9 July 2014

Lack of specific standards for services (access procedures, fruition, territorial characteristics, functions, costs)

Uneven territorial distribution of service supplying (cultural and social differences, infrastructure, etc.)

Summing up… the critical sides

ConclusionsRESULTS AND PERFORMANCE

2. Quality of services: the point of view the supplier Vs the point of view of the user

Themes for working groups

1.Informal care: choice or necessity?

3. A look at the future: what services for Alzheimer’s?

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