Intervento Rovai Scarpelli Uccello Inglese

Beatrice Rovai, CHP/Local Health Unit, area of North-Western Florence

Rossella Scarpelli, CHP/Local Health Unit, area of Florence

Raffaele Uccello, Municipality of Florence

EUROSOCIALNETWORK

System of services for non-self sufficient elderly people

EURO

SOCIALN

ETWO

RK

EURO

SOCIALN

ETWO

RKTITOLO

La gestione delle adozioni internazionali in Italia

THE DEMOGRAPHIC CONTEXT IN SHORTSIZE OF THE ELDERLY POPULATION

Elderly population in Italy: 20.23% of the total populationElderly population in the Province of Florence: 23.63% of the total populationElderly population in the city of Florence: 25.66% of the total population

Ageing index in Italy: 144 (144 people aged 65 and over/100 people aged 14 and less)Ageing Index in the Province of Florence: 183 (183 people aged 65 and over/100 people aged 14 and less)Ageing Index in the city of Florence: 218 (218 people aged 65 and over/100 people aged 14 and less)

Consequently: high incidence of the presence of elderly people in the population of the Province of Florence, with consequences on the social and healthcare policies.

EURO

SOCIALN

ETWO

RKTITOLO


DEFINITION OF NON-SELF SUFFICIENCY

Non-self sufficient are considered those persons, who have permanently, partially or totally lost the autonomy of their physical, sensorial, cognitive and relational skills because of any determined cause with consequent inability to perform the essential acts of everyday life without the relevant help of other people.

Italian regional Law No. 66/2008 (establishing the Fund for non-self sufficient people)

EURO

SOCIALN

ETWO

RKTITOLO


REGIONAL AND LOCAL TARGETS

Improve the quality, the quantity and the pertinence of the care services

Promote the achievement of a system based on the prevention of non-self sufficiency and frailty

Favour care paths which make independent life and home care possible

EURO

SOCIALN

ETWO

RKTITOLO


THE FUND FOR NON-SELF SUFFICIENT PEOPLE

The Tuscan Regional District has set up in 2008 the Fund for non-self sufficient people.

GOALS: sustain and extend the system of integrated public health services in favour of non-self sufficient people with disabilities and elderly people

EURO

SOCIALN

ETWO

RKTITOLO


BENEFICIARIES OF THE FUND

People who are in a condition of non-self sufficiency with a high severity index, verified on the basis of the evaluation carried out by a Multidisciplinary Assessment Team

THE PRINCIPLE OF UNIVERSALISTIC ACCESS IS PUT INTO EFFECT•Only recently stated, but customary active since a long time• It prevails on the concept of residual access (reserved to economic and social underprivileged categories) • Actually, talking about “selective universalism” is more correct(access is guaranteed to everyone, but according to their needs and available resources)

EURO

SOCIALN

ETWO

RKTITOLO


HOW CAN ELDERLY PEOPLE HAVE ACCESS TO THE SERVICES FOR NON-SELF SUFFICIENCY

The access is granted through a procedure, which provides for the intervention of the following actors in the following order:

PUNTI INSIEME (“together points”): reception desk where families can ask for information and for the activation of the procedure for the admittance to the services.

ADMITTANCE SINGLE-POINT (It. PUA): Coordination and management of the procedure of admittance

MULTIDISCIPLINARY ASSESSMENT TEAM: it is an integrated group formed by a doctor, a social worker and a nurse. It is responsible for the assessment of the real needs and for the settlement of a Customized Welfare Project (It. PAP).

PAP: covers home care, residential and/or semi-residential care in conjunction with the needs, with the goals of the intervention and with the severity level.

EURO

SOCIALN

ETWO

RKTITOLO


LEVEL OF GOVERNANCE OF THE SYSTEM

The Community Health Partnership (Public consortium between Municipalities and Territorial Health Units) has the task to provide:

• the management of the services and the adequate organizational solutions for the integrated undertaking of the healthcare and social needs and the wholeness of the diagnostic and welfare activities• the full integration among healthcare, public health and social activities, avoiding redundancies• the planning of territorial activities coherent with the health needs of the population• organizational, technical and managing innovation in the territorial services

EURO

SOCIALN

ETWO

RKTITOLO


EVALUATION INSTRUMENTS OF NON-SELF SUFFICIENCY

The Multidisciplinary Assessment Team makes use of some instruments in order to define the intensity of healthcare need. The evaluation of the level of non-self sufficiency contemplates:• File on the clinical situation by the family-doctor;• BADL test (skills to perform basic activities of daily living) • IADL test (skills to perform instrumental activities of daily living)• Pfeiffer test (short portable mental status)• MDS-HC test (behavioural disorders)• CBI test (caregiver burden inventory)• Social file (socio-economical, family and environmental conditions)• Nursing file (nursing need).

The severity index is determined by algorithms which correlate the test results of the functional/organic field with the cognitive/behavioural one (continues)

EURO

SOCIALN

ETWO

RKTITOLO


Cognitive Impairment(Pfeiffer score)

Dependecy BADL Light

(MDS-ADL score 8-14 or <8 but ≥3 in at

least one ADL)

Dependency BADL Mild

(MDS-ADL score 15-21 or 8-14 but 4 in at

least one ADL)

Dependency BADL Severe

(MDS-ADL score 22-28)

Behavioural/mood disorders

(MDS files integrated score)





None-

Light(0 – 3 no 2)

Mild(4 – 7 or < 4

but one

item = 2)

Severe(8 – 12 or 4 -7

but at least

2 items = 2)

None-

Light(0 – 3 no 2)

Mild(4 – 7 or < 4

but one

item = 2)

Severe (8 – 12 or 4 -7 but at

least 2

items = 2)

None-

Light(0 – 3 no 2)

Mild(4 – 7 or < 4

but one

item = 2)

Severe (8 – 12 or 4 -7 but at

least 2

items= 2)

None-Light (0 – 4)

1 2 3 2 3 4 4 4 5

Mild(5 – 7)

2 2 3 3 3 4 4 4 5

Severe (8–10)

3 3 4 3 4 5 4 5 5

EURO

SOCIALN

ETWO

RKTITOLO


The interventions for non-self sufficient elderly people are based on severity levels from 3 to 5 (in green in the chart above). The persons with lower severity level (from 0 to 2, in red in the chart) do not have the right to access to the interventions financed by the Fund for non-self sufficient people, but can benefit from other resources.

THE ROLE OF THE SOCIAL EVALUATION

Once assessed the level of severity, the socio-environmental situation is fundamental in order to establish the type of healthcare needed (homecare or residential care).

If homecare must be provided the regional model contemplates a relationship between level of severity and provided resources.

EURO

SOCIALN

ETWO

RKTITOLO


HOME CARE SERVICES

• Home care• Adult Day Care Centres (also specific for people suffering from Alzheimer)• Subsidies for family caregivers• Care grants• Meal service• Telecare• Short-term residential care for families’rilief

RESIDENTIAL CARE SERVICES

Nursing home (residential structure with social and health services)

EURO

SOCIALN

ETWO

RKTITOLO


HOW ARE THE SERVICES FINANCED

• Social accountability reports (Municipalities)• Public health reports (Regional Health Service)• Regional Fund for non-self sufficient people• Share on part of the beneficiaries of the services

Social accountability reports

Public health reports

Regional Fund

Sharing by beneficiarie

s

Home care x

x (if public health

integrated) x x

Day care centres x x x x

Subsidies for family caregivers x x(1)

Care grants x x(1)

Meal service x

Telecare x

Nursing homes x x x x

(1) proportional contribution on the basis of revenues and properties (ISEE)

EURO

SOCIALN

ETWO

RKTITOLO


HOW THE SHARING ON PART OF THE BENEFICIARIES IS DETERMINED

The sharing is based on the equivalent economic status indicator (ISEE), a combination of revenues and property (real and personal) of the family, calculated on the basis of the number of members and of the existence of any possible “hard situation” for the family (people with disabilities, minors, …)

For non-self sufficient people the indicator (ISEE), only referring to the beneficiary, is taken into account (the rest of the family is excluded)

In case of reception in a nursing home also the personal and economic situation of the partner and of the children is evaluated.

The level of sharing ranges from zero (corresponding to the exemption threshold) to 100% of the total cost of the service. The cost covered by the public health reports is not subject to any sharing.

EURO

SOCIALN

ETWO

RKTITOLO


FORMS OF ADMINISTRATION OF THE SERVICES

Direct administration (through direct resources or contracts)Indirect administration (agreements/enlistment and possible vouchers)Economic contributions (usually bound to the expenses)

Main examples:

Residential care and day care centres Usually, agreements with private structures and some experiences of vouchering

Home care Usually through contracts with co-operatives. Some experiences of vouchering, which can be spent only at enlisted facilities

Subsidies for family caregivers Reimbursement in favour of the beneficiary bound to the employment of a family caregiver

EURO

SOCIALN

ETWO

RKTITOLO


Thanks for your attention!

Intervento Rovai Scarpelli Uccello Inglese

Health & Medicine

Transcript of Intervento Rovai Scarpelli Uccello Inglese