Long-Term Care in Austria Home Care Europe Conference June 3 rd – 5 th 2009, Vienna Mag. Kurt...
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Transcript of Long-Term Care in Austria Home Care Europe Conference June 3 rd – 5 th 2009, Vienna Mag. Kurt...
Long-Term Care in Austria
Home Care Europe Conference
June 3rd – 5th 2009, Vienna
Mag. Kurt Schalek
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 2
Long-Term Care in Austria
Framework of LTC Austria is a federal state
• Competencies are split between federal and nine provincial governments
• Federal activities are consistent in all provinces
• Provincial activities differ between nine provinces
Separation of health care and social system• LTC is primarily subject of the social care system
• Health care is involved in LTC when people are sick
• Difficulties in offering integrated services
LTC in Austria is a complex system• Many players in the field
• Differences for beneficiaries dependent on the province
• Complex political processes within this system
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 3
Long-Term Care in Austria
Benefits and Services
Cash benefits• Long-Term Care benefit
• Social assistance
Non-cash benefits, services• Services (e.g. home care, nursing homes, counselling)
• Facilities (e.g. walking frames, support of age-appropriate adaption of houses and flats, nursing beds)
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 4
Players in the LTC-System
Federal Ministry Federal Ministry of Social Affairsof Social Affairs
LTC benefit (7 levels), social security for uninsured informal carers, financial support for investments
and holidays for the major informal carer
Health Care Health Care InsuranceInsurance
Medical home care (nurses) if hospital care is substituted, assistive technology (e.g. walking frames)
Authorities of Authorities of ProvincesProvinces
LTC benefit on provincial level, all kinds of services in LTC, social assistance for residents in nursing homes and clients of home care
MunicipalitiesMunicipalities Services in LTC, social assistance for residents in nursing homes, other financial support, assisted living facilities
Individual/FamiliesIndividual/Families co-payments/deductibles, private investments in assistive technology, services etc., informal care by family carers (75-80% informal arrangements)
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 5
Sources of finance in LTC
Federal Ministry Federal Ministry of Social Affairsof Social Affairs
Cash-benefits financed by taxes
Health Care Health Care InsuranceInsurance
Financed by wage-dependent insurance premiums and tax-financed deficit coverage
Authorities of Authorities of ProvincesProvinces
Services and benefits financed by taxes and co-payments
MunicipalitiesMunicipalities Services and benefits financed by taxes and co-payments
Individual/FamiliesIndividual/Families Financed by income and/or private capital, non-paid services by informal carers
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 6
Long-term care benefit financial support for people in need
Purpose of LTC-benefit (§1 BPGG): • Overall financial contribution to costs related to the need for care/nursing
• Furthering opportunities for a self-determined living according to individual requirements
Beneficiaries are classified in 7 levels• From level 1 (least) to level 7 (highest)
Preconditions for entitlement• Living in Austria (under specific circumstances also in EWR-Countries)
• Need for care/nursing is expected to last longer than 6 months
• Application for LTC-benefit or for reclassification by (potential) beneficiary
• Medical examination for assessing need for care according to law
• Notification by the responsible authority
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 7
Long-term care benefit 7 levels of need for care
Preconditions Level € per month
Need for care/nursing more than 50 hours per month 1 154,20 Euro
Need for care/nursing more than 75 hours per month 2 284,30 Euro
Need for care/nursing more than 120 hours per month 3 442,90 Euro
Need for care/nursing more than 160 hours per month 4 664,30 Euro
Need for care/nursing more than 180 hours per month AND • Extraordinary need has to be covered
5 902,30 Euro
Need for care/nursing more than 180 hours per month AND• Care is needed during whole day (day and night) on a regular
basis and time of need is not predictable OR • Continuous presence of a caring person is necessary because
the concerned person is likely to endanger her-/himself or other people.
6 1.242,- Euro
Need for care/nursing more than 180 hours per month AND• Lack of the ability to move all four extremities intentionally in
order to fulfil functional tasks OR• Existance of any comparable condition
7 1.655,80 Euro
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 8
Long-term care benefit
How does the classification work? Need for care is expressed in time value for tasks
• e.g. washing an incontinent person: 4 x 10 min per day
3 ways how time for tasks can be valued• guide values: can be fixed individually by assessing experts• minimum values: exceeding has to be justified• fixed extra values: can be added for specific groups of clients (e.g.
demented people, disabled children)
Law restricts assessment to body-related & functional tasks• ADL: dressing, washing, mobility, eating and drinking (including artificial
feeding), elimination, intake of medicine, anus-praeter-care, care of canula, tubes, catheter, klysma
• I-ADL: purchase of food and medicine, heating, washing laundry• Disregarded aspects: communication, relation-building, surveillance when
time value less than 180 h/month, psychological aspects (e.g. fear), systemic aspects of care (e.g. care-related conflicts with informal carers)
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 9
Long-term care benefit
Problematic aspects Politicians regard results of LTC-benefit assessments
increasingly as indicator for need of care. But:
Assessment doesn’t give a full description of need for care• It is designed for distribution of an overall financial contribution only• Time values are designed to fit administrative processes but does not
reflect real values• Need for care must be justified by medical expertise instead of nursing
diagnoses that are more significant• Assessment doesn’t encompass all dimensions of care (ability for self-
care/resources, context factors and goals)• Lack of a standardised assessment tool • Assessment tools are not scientifically evaluated• Assessment focuses on a single moment only, not on a period of time
Access of beneficiaries to other benefits or support programs could be limited by inadequate assessment
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 10
Long-term care benefit Structure of beneficiaries 2007
Level of LTC-
benefit
Beneficiaries federal
level%
Beneficiaries
Prov.’l level% Total %
1 76.444 21,8% 12.566 20,6% 89.010 21,6%
2 119.086 33,9% 19.428 31,9% 138.514 33,6%
3 57.372 16,3% 11.266 18,5% 68.638 16,7%
4 53.942 15,4% 7.734 12,7% 61.676 15,0%
5 28.397 8,1% 4.673 7,7% 33.070 8,0%
6 9.732 2,8% 3.301 5,4% 13.033 3,2%
7 6.084 1,7% 1.979 3,2% 8.063 2,0%
Total 351.057 100,0% 60.947 100,0% 412.004 100,0%
Number of beneficiaries 2007
55,2 %
71,9 %
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 11
Total beneficiaries 2007: 411.976• Federal LTC beneficiaries: 351.057
• Provincial LTC beneficiaries: 60.919
Total cost of LTC benefit 2007 € 2.001,8 million
• Cost on federal level: € 1.691,5 million
• Cost on provincial level: € 310,3 million
Long-term care benefit No. of beneficiaries and cost
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 12
Financing of LTC servicesA basic model
beneficiaries
Federal government
Provinces/Municipalities
public providers
LTC-benefit
sick funds
other sourcese.g. donations, sponsors
medical home care only
NOTE: This is a general model only. Variations occur in every province.
social assistance for those who can’t afford co-payments
rewards on basis of service agreements
servi
ces
co-paymentsco
-pay
men
ts
serv
ices
private providers
informal care
services and financial supportsocial security for uninsured family carers
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 13
Financing of LTC services
Variations in Austrian provinces
Bgld. Knt. NÖ OÖ Szbg. Stmk. Tirol Vlbg. Wien
Minimum Nurse € 26,10 € 0,-/€ 7,- € 9,10 € 0,80 € 0,00
€ 6,69 € 3,80 € 22,00 € 0,00
per h NA € 20,80 € 0,-/€ 6,- € 9,10 € 0,80 € 0,00 € 4,87 € 3,00 member fee € 0,00
HH € 15,90 € 0,-/€ 8,- € 9,10 € 0,80 € 0,00 € 2,98 € 2,30 € 8,00 € 0,00
Maximum Nurse € 24,90 € 30,00 € 28,00 € 20,70 € 28,10 € 36,26 € 38,76 € 33,00 € 22,13
per h NA € 19,90 € 26,00 € 23,00 € 20,70 € 26,50 € 26,38 € 33,79 member Fee € 22,13
HH € 15,30 € 22,00 € 20,00 € 20,70 € 26,50 € 16,50 € 29,14 € 13,00 € 16,86
€ of LTC-benefit Nurse € 6,00 € 5,70 € 3,93 € 6,00 € 6,00 € 6,18
per h NA € 6,00 € 5,70 € 3,93 € 6,00 € 4,90 € 4,36
HH € 5,70 € 3,93 € 6,00 € 3,80 € 2,91
Also variations in• mode of client allocation (decentralised/centralised models)
• maximum extent of public supported service hours
• mode of accounting (e.g. rewards per service hours, service quota)
Variations in co-payments by beneficiaries
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 14
Cash benefits vs. non-cash benefits/services• Cost for cash benefits (2006): € 1.925,04 million• Cost for services/non-cash benefits (2006): € 1.332,34 million • forecast: cost for services will raise faster than cost for cash-benefits
Cost by territorial authorities• Cost on federal level (LTC-benefit, 2006): € 1.621,40 million• Cost on provincial level (2006): € 1.635,74 million• Cost on municipal level (estimation): € 400,00 million• Provincial expenditures will increase faster than on federal level
Public expenditures vs. private effort• Public expenditures in LTC (2006): € 3.257,38 million• Estimated value of informal care: € 2 – 3 billion• Estimated co-payments by beneficiaries: 550 million• No data on care-related private expenditures available
Financing of LTC services Structure of cost
Sources: WIFO (2008), Quantum (2007), Schneider et al. (2006)
Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek 15
Thank you for your attention!
ContactKurt SCHALEKÖsterreichische Caritas Zentrale (ÖCZ)Albrechtskreithgasse 19-21, A-1160 ViennaPhone: 0043 1 488 31-436eMail: [email protected]