LONG-TERM CARE SYSTEM ELDERLY CARE IN FLANDERS

Transcription

1 LONG-TERM CARE SYSTEM ELDERLY CARE IN FLANDERS 28 November 2017

2 KEYWORDS > Welfare and health : keys to quality of life for young and old > Core concepts : autonomy and solidarity the demands, needs, autonomy, freedom of choice and quality of the elderly person > Organisation : demand-led & person-driven > Financing : person-linked financing system Agentschap Zorg en Gezondheid 2

3 PEOPLE-CENTRED AND INTEGRATED HEALTH SERVICE D - Criteria, used to guide the choice of the patient, are based on the level of selfreliance. - The choice is discussed with general practitioner and/or the administrator Agentschap Zorg en Gezondheid 3

4 THE TARGET-GROUP Agentschap Zorg en Gezondheid 4

5 TRENDS AND DEVELOPMENTS 1. Higher level of education, greater vitality and more outspoken 2. Reduced family size and growing number of single persons 3. Greater diversity 4. Disadvantage among elderly people 5. Medical and technological developments 6. Market forces within welfare and care Agentschap Zorg en Gezondheid 5

6 STRENGTHS AND WEAKNESSES OF THE CARESYSTEM > High degree of informal care > Growing residential care provision > Large diversity > Freedom of choice > Accessibility > Quality > Enhanced professionalisation > Growing scientific knowledge > Increasing technological support > Insufficient prevention > Insufficient early detection & intervention > Too supply-led > Not sufficiently demand-led > Fragmented > Lack of coordination > Lack of continuity > Abundance/shortage of information > Affordability under pressure Agentschap Zorg en Gezondheid 6

7 PARADIGMASHIFT > Resource-led care > The elderly person in the passenger seat of his care > Silo thinking in care and welfare > Uni-disciplinary > Illness and curing > Everyone for themselves > Cure > Input > Residential > Institutional financing > Informal care in the margin > Demand-led care > The elderly person at the wheel of his care > Integrated care networks > Inter- and multi-disciplinary > Health and behaviour > Warm, caring neighbourhood > Prevention, care and cure > Outcome > Non-residential > Person-linked financing > Informal care as full partners Agentschap Zorg en Gezondheid 7

8 STATE-STRUCTURE: 6TH STATE REFORM : 3 regions Flanders Region 3 communities Walloon Region Brussels-Capital Flemish Community Frenchspeaking Community German speaking Community Agentschap Zorg en Gezondheid 8

9 BUDGET CARE AND HEALTH BUDGET ZORG EN GEZONDHEID 2015 Rehabilitation 6% Care Insurance 10% Hospitals and Mental Health Miscellaneous Care 1% 5% THAB 10% Prevention 2% Home Care 16% Primary Care 1% Elderly Care 49% Agentschap Zorg en Gezondheid 9

10 SUPPLY RESIDENTIAL CARE (1 MAI 2017) Number Recognised units Residential care centres Residential care centres, recognised nursing homes Centres for short stay Centres for daily care Groups of assisted housing Centres for rehabilitation November, 2017 Agentschap Zorg en Gezondheid 10

11 HOME CARE & RESIDENTIAL CARE Home care: a variety of services for care and support of people at home, the household; body care; care by nurses. Service flats : a facility where the elderly with lower care needs, can live together with other elder people. Residential care : a facility for the elderly with high care needs permanently : nursing homes temporarily short period short stay : a nursing home day or night : a day care centre For rehabilitation: a centre for rehabilitation Agentschap Zorg en Gezondheid 11

12 ACCREDITATION AND CONTROL OF FLEMISH ELDERLY CARE FACILITIES > Competence of Flanders : License : the number of permitted units is yearly fixed based on the forecasting in 5 years of the number of elderly people above 65y per municipality. Currently, licensing is suspended till Accreditation : only facilities with a license receive an accreditation. NO operation without accreditation! Subventions : full competence since the 6th State reform Inspection : competence of the Flanders Care-inspection Monitor, remedy and sanction problematic situations in elderly facilities: competence of our team Care for the Elderly Agentschap Zorg en Gezondheid 12

13 FINANCING: FLAT RATE PER SETTING (RESIDENTIAL CARE AND SHORT STAY) > Every setting receives a specific flat rate based on: The case mix in ROB/RVT/KVB during a reference period; All other financial elements (eg. the available personnel) The information delivered by the settings via a web application; > The flat rates are paid by the insurance companies > A control system is applied for the evaluation of the degree of care independency of the patients and can be used as basis for sanctions Agentschap Zorg en Gezondheid 13

14 FLAT RATE PER SETTING (RESIDENTIAL CARE AND SHORT STAY) (2) Principles: > Yearly flat rate (calendar year pivotal index) > Invoiced per day of stay, per entitled resident > Via the insurance companies (FL -> Care fund) > For the entire setting > Calculation based on a reference period Agentschap Zorg en Gezondheid 14

15 FLAT RATE PER SETTING (RESIDENTIAL CARE AND SHORT STAY) (3) What is financed? > Care professionals Nurses Speech therapy, physiotherapy Reactivation and social reintegration Occupational therapy Additional qualifications: reference person dementia, coordinating and counselling medical doctor, chief-nurse, > Material Care material Products and material for the prevention of nosocomial diseases > Personal training and awareness raising for palliative care > Management costs and costs for the data transfer Agentschap Zorg en Gezondheid 15

16 PRICE POLICY IN A RESIDENTIAL CARE CENTRE Annual indexing of the daily rate 1 x per year; According to the consumption index No approval needed from the Agency Care and Health To be communicated to the Agency Care and Health The price for a new service or new product The centre can determine the price but must communicate it first to the Agency The new price (e.g. a new room type) has to be justified. Increasing or decreasing the price of an existing service: Only after approval of the Minister Limitations on the average price increase and on the increase per type of room. Increases are introduced with the Agency Care and Health Decreases need to be informed Agentschap Zorg en Gezondheid 16

17 THE RESIDENTIAL CARE LINE - WOONZORGLIJN > The residential care line provides information and treats complaints about elderly care facilities. > Everyone can file a complaint to the residential care line even anonymously. > Single Contact point: By phone from Monday till Friday from 9.00 u u. By woonzorglijn@zorg-en-gezondheid.be Website : > Yearly report %20Woonzorglijn%20in% pdf Agentschap Zorg en Gezondheid 17

18 RESIDENTIAL CARE LINE CALLS ACCORDING TO THE TYPE OF CALLS (FIGURES ) Type of call 2013 figures % Request for information 2014 figures % ,9% ,1% Communication 53 2,4% 37 1,7% Complaints 104 4,7% 112 5,2% Total ,0% ,0% Most reported complaints with regards to the residential care centres 1 Care and support 2 Staffing in general 3 Meals Agentschap Zorg en Gezondheid 18

19 CARE INSPECTION AND CONTROL When do we inspect? When granted an accreditation, a follow-up inspection, an extension or a new building, after complaints. What is investigated? The quality of the daily operation: the organisation of everyday life, hygiene, maintenance, relationship with the residents... The accreditation requirements, eg. personnel standard, price policy, call system, infrastructure standards, etc... Thematic inspections, eg. hand hygiene, fixation... A specific investigation for a reported complaint or communication. Can be done anonymous or by mentioning the person(s) complaining Agentschap Zorg en Gezondheid 19

20 FUTURE - CHALLENGES > Implementation of the 6th State reform > New financial system within Flanders Social Protection - VSB > Reorganisation of the structure of the primary healthcare > Promoting integrated/coordinated care-organisation (coproduction) Agentschap Zorg en Gezondheid 20

21 6TH STATE REFORM > Opportunity for policy development in Flanders: Elderly care : inclusive financing, pricing policy and support to the Elderly Care - THAB Residential care Primary care Home care > More coordinated care across sectors -> integrated care > New model for financing: Person-linked financing system : Care budget and Care ticket One taxonomy: BelRAI Agentschap Zorg en Gezondheid 21

22 VSB CARE BUDGET AND CARE TICKET > Care budget free to use ZVZ: care insurance care budget for persons with a high care need THAB: financial support for the elderly care budget for elderly with a care need BOB: budget for elementary support > Possible integration of ZVZ, THAB, BOB > Care ticket acknowledged care Family care and additional home care Residential elderly care Mental health care Rehabilitation Mobility equipment

23 VSB PRINCIPLES OF THE PERSONALIZED BUDGET > Person-linked financing is based on the objective care need of the person, measured with BELRAI and, where appropriate, with supplementary instruments of diagnostics and indication Care component (personalized) Organization component (costs linked to the setting) > Drawing rights financial support for acknowledged care (cash experiments) > Based on the care need and to be developed per sector: BelRAI-LTCF.

24 VSB LEGAL TIMELINE First Decree VSB Start BOB Integration financial support for the elderly New Decree VSB Residential care centers and mobility equipment 24 juni 2016 September 2016 Januari juni Mental health care, rehabilitation, homecare Na 2019 model care insurance is expanded with the budget for elementary support and the financial support for the elderly Legal endorsement of the basic principles and the frame for a further expansion with home care, elderly care, mental health care, rehabilitation and mobility equipment Agentschap Zorg en Gezondheid 24

25 LOOKING FORWARD TO YOUR QUESTIONS Agentschap Zorg en Gezondheid 25