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Elizabeth Mestheneos and Judy Triantafillou
on behalf of the EUROFAMCARE group
Supporting Family Carers of Older People in Europe –
the Pan-European Background
Supporting Family Carers of Older People in Europe –
Empirical Evidence, Policy Trends and Future Perspectives
Edited by
Hanneli Döhner and Christopher Kofahl
University of Hamburg
Elizabeth Mestheneos and Judy Triantafillou
on behalf of the EUROFAMCARE group
Supporting Family Carers of Older People in Europe – the Pan-European Background
This report is part of the European Union funded project
“Services for Supporting Family Carers of Elderly People in Europe: Characteristics, Coverage and Usage” - EUROFAMCARE
EUROFAMCARE is an international research project funded within the 5th Framework Programme of the European Community, Key Action 6: The Ageing Population and Disabilities, 6.5: Health and Social Care Services to older People, Contract N° QLK6-CT-2002-02647 "EUROFAMCARE"
http://www.uke.uni-hamburg.de/eurofamcare/
All rights by the authors and the EUROFAMCARE-consortium.
EUROFAMCARE is co-ordinated by the University Medical Centre Hamburg-Eppendorf, Institute for Medical Sociology, Dr. Hanneli Döhner Martinistr. 52 20246 Hamburg Germany
This report reflects the authors’ view. It does not necessarily reflect the Euro-pean Commission's view and in no way anticipates its future policy in this area.
Designed and edited by Christopher Kofahl
Final Layout: Maik Philipp, Florian Lüdeke, Christopher Kofahl
Content
5
Content
Preface by the Editors: A Short Description of EUROFAMCARE..................... 9
The EUROFAMCARE Network ....................................................................... 11
Introduction by the Authors ............................................................................. 13
1 Background to the Report ........................................................................... 14
1.1 The EUROFAMCARE Study ................................................................. 14
1.2 Data Analysis......................................................................................... 15
1.3 Analytic Matrices ................................................................................... 16
1.4 What is Family Care? ............................................................................ 17
2 Key Issues................................................................................................... 19
2.1 Demographic Trends............................................................................. 19
2.2 Legal Obligations and Family Care and the Role of the State .............. 19
2.3 The Role of Family Care and Social Attitudes....................................... 21
2.4 The “Work” of Caring............................................................................. 23
2.4.1 Family Carers .................................................................................... 23
2.4.2 Characteristics of Family Carers ....................................................... 24
2.4.3 Is Family Care ‘real’ Work? ............................................................... 27
2.4.4 Reciprocity in Family Care Work ....................................................... 30
2.4.5 Professional Paid Care...................................................................... 31
2.4.6 Migrant and foreign Care Workers, legal and illegal ......................... 33
2.4.7 The Voluntary Sector......................................................................... 34
2.4.8 The Future of Care Work................................................................... 35
2.4.9 New Technologies............................................................................. 36
2.5 Public Investment in Care and Family Care of Older People................ 37
2.5.1 The Right to receive Care.................................................................. 37
2.5.2 Approaches to Carer Support............................................................ 38
2.5.3 The Rights of Family Carers and their financial Recognition ............ 39
2.5.4 Long-term financial Support .............................................................. 40
2.5.5 Formal Service Provision for older People (health, social services, residential) ......................................................................................... 41
2.5.6 Services for older People at Home.................................................... 42
EUROFAMCARE – Pan-European Background Report
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2.5.7 Services for Family Carers ................................................................ 46
2.6 Residential and Long-Term Care .......................................................... 47
2.6.1 Sheltered Housing Units.................................................................... 51
2.6.2 Hospices and palliative Care............................................................. 51
2.6.3 Residential Respite Care................................................................... 51
2.6.4 Training and Quality Control and Family Carer Involvement............. 52
2.7 Current Policy Trends and Debates ...................................................... 52
3 Conclusions and Policy Implications ........................................................... 56
3.1 More Services for Family Carers and older People............................... 56
3.2 Financial Support................................................................................... 58
3.3 Working Carers...................................................................................... 59
3.4 NGOs, Advocacy, Information, legal Advice, Counselling..................... 60
3.5 Formal Labour Force............................................................................. 61
3.6 Needs Assessment ............................................................................... 62
3.7 Promotion of Health and Well-being for Family Carers ......................... 62
3.8 Evaluation and Monitoring..................................................................... 63
3.9 Integrated Care and Training ................................................................ 64
3.9.1 Professionals ..................................................................................... 64
3.9.2 Family Carers .................................................................................... 64
3.9.3 Volunteers ......................................................................................... 65
4 References .................................................................................................. 66
5 Annexes ...................................................................................................... 69
5.1 Annex 1 ................................................................................................. 69
5.1.1 NABARES Country List and Abbreviations ....................................... 69
5.1.2 NABARES Analytic Matrices and Abbreviations in Matrices............. 70
5.2 Annex 2 – Future Research Needs ....................................................... 71
5.3 Annex 3 – STEP for NABARES ............................................................ 73
5.4 Annex 4 – List of Social Services for Older People............................... 74
5.5 Annex 5 – Matrix Services for Family Carers for 23 Countries ............. 75
5.6 Annex 6 – Matrix of Family Carers’ Legal Position and Recognition by State ...................................................................................................... 78
Content
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5.7 Annex 7 – Matrix Residential Care Services (Institutional care, includes residential homes, nursing homes, short and long term care hospitals)88
5.8 Annex 8 – Matrix of Home Based Services......................................... 108
5.9 Annex 9 – Matrix: Care of dependent older People – current and future Supply of formal and informal Care Givers ......................................... 125
5.10 Annex 10 – Matrix: Other Issues ......................................................... 142
Short Description of EUROFAMCARE
9
Preface by the Editors: A Short Description of EUROFAMCARE
EUROFAMCARE is the acronym of the project “Services for Supporting Family Carers of Elderly People in Europe: Characteristics, Coverage and Usage” funded by the EU within the 5th Framework Programme “Quality of Life and Management of Living Resources”. As part of the Key Action 6: The Ageing Population and Disabilities; 6.5: Health and Social Care Services to older Peo-ple, it aims to provide a European review of the situation of family carers of elderly people in relation to the existence, familiarity, availability, use and ac-ceptability of supporting services.
Six-Country Study
In 2003 six countries (Germany, Greece, Italy, Poland, Sweden, United King-dom) formed a trans-European group representing some of the different types of welfare-states in Europe and started a comparative study. Each country col-lected data from about 1,000 family carers who care for at least four hours a week for their dependent elderly (65+) family members in different regional sites. The family carers were interviewed face-to-face at home using a joint family care assessment instrument.
The views of potential service providers involved were obtained in 2004. Quantitative and qualitative data from these interviews were entered in Na-tional Data Sets and a European data base compiled for cross-national analy-sis. A typology of care settings will be developed considering examples of good practice and beneficial and obstructive circumstances.
Pan-European Review
Pan-European expertise, knowledge and background information about the support, relief and expertise of family carers, recognising the variety of the dif-ferent social, health and welfare systems in an expanding Europe, have been achieved by reviews and expert interviews in the six project countries plus 17 further European countries.
AGE – the European Older People's Platform – as a member of the EURO-FAMCARE group is contacting and informing policy makers and NGOs on the European level and monitoring the development of actions for family carers. AGE aims to raise awareness about the issue of family care and to stimulate the political discourse.
Socio-Economics
A socio-economic evaluation, on the basis of the National Surveys and the pan-European background information, will calculate the economic conse-quences of family care, from perceived quality of life to European-wide politico-economic implications.
EUROFAMCARE – Pan-European Background Report
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Transfer and Dissemination
The last step is a feedback research action phase based both on the study re-sults and on the pan-European expertise. A European Carers’ Charter in pro-gress will be further developed by the new European network organisation EUROCARERS in order to stimulate further activities both on national and European policy levels.
To promote wider and continuous transfer and dissemination, EUROFAM-CARE reports and results will be published in a series called “Supporting Fam-ily Carers of Older People in Europe – Empirical Evidence, Policy Trends and Future Perspectives”. The Pan-European Background Report is the first publi-cation of the series. The National Background Reports from 23 European countries – the basis of the Pan-European Background Report – will follow this publication.
We hope this will help to increase public recognition and support of all those who are caring for their elderly family members.
Hamburg, October 2005
Hanneli Döhner and Christopher Kofahl
The EUROFAMCARE Network
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The EUROFAMCARE Network
The Members of the EUROFAMCARE Group
� Germany, Hamburg: University Hospital Hamburg-Eppendorf, Centre of Psychosocial Medicine, Social Gerontology, University of Hamburg (Co-ordination centre) – Hanneli Döhner (Co-ordinator), Christopher Kofahl, Susanne Kohler, Daniel Lüdecke, Eva Mnich, Nadine Lange, Kay Seidl, Martha Meyer
� Germany, Bremen: Centre for Social Policy Research / Centre for Applied Nursing Research, University of Bremen – Heinz Rothgang, Roland Becker, Andreas Timm, Kathrin Knorr, Ortrud Olessmann
� Greece: SEXTANT Research Group, Department of Health Services Management, National School for Public Health (NSPH), Athens – Elizabeth Mestheneos, Judy Triantafillou, Costis Prouskas, Katerina Mestheneos, Sofia Kontouka
� Italy: INRCA Dipartimento Ricerche Gerontologiche, Ancona – Giovanni Lamura, Cristian Balducci, Maria Gabriella Melchiorre, Sabrina Quattrini, Liana Spazzafumo, Francesca Polverini, Andrea Principi, Marie Victoria Gianelli
� Poland: Department of Geriatrics, The Medical University of Bialystok; Insitute of Social Economy, Warsaw School of Economics and Institute of Philosophy and Sociology, University of Gdansk – Barbara Bien, Beata Wojszel, Brunon Synak, Piotr Czekanowski, Piotr Bledowski, Wojciech Pedich, Mikolaj Rybaczuk, Bożena Sielawa, Bartosz Uljasz
� Sweden: Department of Health and Society, Linköping University – Birgitta Öberg, Barbro Krevers, Sven Lennarth Johansson, Thomas Davidson
� United Kingdom: SISA - Community Sciences Centre and School of Nursing & Midwifery, Northern General Hospital, University of Sheffield – Mike Nolan, Kevin McKee K, Jayne Brown, Louise Barber
� AGE - The European Older People’s Platform, Brussels, Belgium – Anne-Sophie Parent, Catherine Daurèle, Jyostna Patel, Karine Pflüger, Edward Thorpe
The Members of the Pan-European Group:
� Josef Hörl (Austria)
� Anja Declerq, Chantal Van Audenhove (Belgium)
� Lilia Dimova, Martin Dimov (Bulgaria)
� Iva Holmerová (Czech Republic)
EUROFAMCARE – Pan-European Background Report
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� George W. Leeson (Denmark)
� Terttu Parkatti, Päivi Eskola (Finland)
� Hannelore Jani (France)
� Zsuzsa Széman (Hungary)
� Mary McMahon, Brigid Barron (Ireland)
� Dieter Ferring, Germain Weber (Luxembourg)
� Joseph Troisi (Malta)
� Reidun Ingebretsen, John Eriksen (Norway)
� Liliana Sousa, Daniela Figueiredo (Portugal)
� Simona Hvalic Touzery (Slovenia)
� Arantza Larizgoita Jauregi (Spain)
� Astrid Stückelberger, Philippe Wanner (Switzerland)
� Geraldine Visser-Jansen, Kees Knipscheer (The Netherlands)
The Members of the International Advisory Board
� Robert Anderson, European Foundation for Improvement of Living and Working Conditions, Dublin
� Janet Askham, King's College London, Institute of Gerontology, Age Concern, London
� Stephane Jacobzone, OECD, Social Policy Division, Paris
� Kai Leichsenring, European Centre for Social Welfare Policy and Research, Wien
� Jozef Pacolet, Catholic University of Leuven, Higher Institute of Labour Studies Social and Economic Policy, Leuven
� Marja Pijl, The Netherlands Platform Older People and Europe (NPOE)
� Joseph Troisi, University of Malta, Institute of Gerontology
� Lis Wagner, WHO - European Office, Kopenhagen
Every partner in the six core countries is also support by a National Advisory Group.
Introduction by the Authors
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Introduction by the Authors
Many European and national reports have been written about the issue of care for older dependent people.1 This report is designed to focus on family carers of older people and their situation while later we consider how services do and do not help those who, in virtually every country studied in this report, provide a vast amount of care and support – those termed family and informal carers. It has been designed to be brief, to provide an overview of the 23 countries through their National Background Reports (NABAREs), and to act as a stimu-lus to all those involved in issues related to care.
The report rests on the expertise of the authors of the national reports and those interested in specific details for each country should examine these re-ports. Both the final draft of this report and the matrices attached to the report have been circulated between the authors for feedback and final adaptations. The country specific findings and suggestions were re-assessed in the context of the findings from the other NABAREs. We thank all authors for their addi-tional engagement in checking this report in order to improve consistency and reliability.
It is hoped that family carers, policy makers and service providers will find something of interest in this report and that it will provide ideas about how best to move forward in supporting both family carers and older dependent people. At the EU level, the family care of dependent older people is being increasingly recognised as a significant issue, related as it is to the three keystones of ac-cessibility, quality and sustainability of health care systems, to social inclusion and work (labour market).
Elizabeth Mestheneos and Judy Triantafillou
1 Related studies and programmes include CARMEN, FELICIE, IPROSEC, OASIS, PROCARE,
SHARE, SOCCARE, European Observatory on the Family, European Foundation studies and re-
ports from these and WHO reports. See References.
EUROFAMCARE – Pan-European Background Report
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1 Background to the Report
1.1 The EUROFAMCARE Study
In all EU countries, the responsibility for the provision of and payment for long-term care is divided between the four sectors of what has been termed the “welfare diamond” (Pijl 1994), namely:
� Family and informal care sector
� State or public sector
� Voluntary and non-governmental-organisation (NGO) sector
� Care market or private sector
The balance of care provision in each country depends on a mixture of factors such as tradition, legal responsibilities, health and social policy, national budg-ets and national wealth and, last but not least, demographic trends regarding fertility levels and life expectancy, which affect the availability of informal family carers.
There are substantive differences between countries in Europe as to how care is provided. Those with poorly funded welfare states and a continuing associa-tion between poverty and old age, such as Greece and Spain, are associated with low service provision limited to those who can pay or who lack alternative sources of care, whereas in those countries with very high taxation, such as Denmark, demand for services as a taxpayer’s right is high. However since demand is potentially infinite, even countries which provide services as a citi-zen’s right inevitably have to introduce a system of rationing, usually based on needs assessment (objective assessment of need for a service) and means testing (income and assets assessment of the older people and / or family car-ers) to ascertain the older person’s ability to make a financial contribution to payment for care. The former Communist regimes with their previous welfare infrastructures are gradually being reconstructed with a plurality of partners from state, local authority, NGO and private sectors.
Despite wide variations in systems of formal care provision for dependent older people, in all the 23 EUROFAMCARE countries the vast majority of care is provided by individual family members within the informal care sector. In countries such as Sweden, where the state has traditionally been a main pro-vider of care, the need to contain increasing costs2, in combination with the stated preferences of older people themselves to remain in their home envi-ronment for as long as possible, has led to what has been described as a “re-discovery of family care” (Johansson 2004). This involves various measures to 2 With a total tax pressure at 50% Swedes expect comprehensive care services and meeting addi-
tional caring costs by increasing income tax further would not appear to be a political option.
Background to the Report
15
promote and support the increased participation of the informal care sector via the public and voluntary / NGO sectors3.
The EUROFAMCARE study focuses on this major contribution of family carers of older dependent people in Europe to the overall provision of long-term care, by compiling comparative data on the situation of family carers through:
� National Background Reports (NABAREs) describing the current situation of family carers in 23 EU countries (AT, BE, BU, CH, CZ, DE, DK, EL, ES, FI, FR, HU, IE, IT, LU, MT, NL, NO, PL, PT, SE, SI, UK). http://www.uke.uni-hamburg.de/extern/eurofamcare/presentations.html
� A Pan-European Background Report (PEUBARE) based on the NABAREs and covering national and European policies and their implications
� National Surveys (NASURs) providing primary data on the experiences of family carers and service use, collected during interviews with 1000 family carers in each of the six core countries (DE, EL, IT, PL, SE, UK)
� A Trans-European Survey Report (TEUSURE)
� A Socio-economic Evaluation (ECO) and a European Policy Analysis
� Research Action (REACT), the final phase of the study, consisting of activities at the local, national and EU level, which aim to improve the situation of family carers
The aim of the NABARES was to collect systematic and comparable data on the situation of family carers in each country, based on a Standardized Evalua-tion Protocol – STEP (Annex 3), to facilitate the comparative analysis to be used for the production of this Pan-European Background Report. As a corol-lary to the STEP for the NABARES, the authors were asked to write three overviews with key points to be used for national and EU policy recommenda-tions in the final phase of the project and aimed at:
� Representative organisations of family carers and older people
� Service providers
� Policy makers
1.2 Data Analysis
Despite the use of a detailed Standardized Evaluation Protocol, the main prob-lem in analyzing the NABARES was both the lack of data on family carers from many countries and the wide variation in how available data were recorded, leading to non-comparability of findings between countries. Despite these diffi-
3 The voluntary/NGO sector in many European countries contracts with the public sector to organise
and provide services, thus acting essentially as an enterprise. This is distinct from the work of in-
formal, non paid volunteers.
EUROFAMCARE – Pan-European Background Report
16
culties, the authors have selected and focused on key aspects relating to care for dependent older people and some of the key issues which recurred in most reports and have tried to draw some conclusions on the present state of family care in those 23 countries, with a view to making recommendations for future policy for the support of family carers at both national and EU levels.
Family carers currently provide the vast majority of care for dependent older people in all the countries studied, with strong indications that they will con-tinue to do so in the foreseeable future. Thus, one of the main themes of the report are the different methods of support for family carers to give them choices in what aspects of care they provide, to enable them to provide care without damage to their own physical, mental and social well-being and to avoid long term poverty.
The short and long term outcomes and impact of the different types of support for the well-being of older people and family carers, as well as for national and EU economies, are also referred to, although these issues are examined in depth in the socio-economic and policy reports.4
1.3 Analytic Matrices
Using the data from the 23 reports, 8 matrices were developed as a way of analysing the large amount of data; these have been used as the basis for the report. The matrices include:
� Legal position of family carers and recognition by the state
� Labour force, informal and formal
� Home-based services for older people
� Services for the support of family carers
� Residential care
� Other issues
� Current policy debates
� Recommendations and future research needs
6 of these matrices are found in Annex 1, the matrix "future research needs" is in Annex 2, whereas "current policy debates" and "recommendations" have been incorporated into the text in sections 2.7 and 3 of the report.
4 ECO and the Social Policy Report
Background to the Report
17
Throughout the text, stars indicate brief descriptions of interest-ing, innovative or good practice. It should be noted that these simply provide examples from each country and are not meant to be an extensive and complete list. Full details of good practices can be found in the National Background Reports referred to and available on: http://www.uke.uni-hamburg.de/extern/eurofamcare/ presentations.html
1.4 What is Family Care?
The relations between people are based on social reciprocity, often reflected in legal contracts, and including obligations set up between people, typically kin, over a life time. Family carers of all kinds and of all ages, grow up with their society’s social norms and obligations. They also belong within a larger value and ideological system of political and religious belief – capitalism and free market systems, socialism, communism, Catholicism, Protestantism and Or-thodoxy, Judaism, Islam- which enshrine in certain dogma the values attached to care for one another, the role of the family and of women. The historic change in Europe has been towards the development of societies and econo-mies that offer people far more choices regarding the kinds of relationships they will set up (Giddens 1991).
Defining the nature of family care for older people who need a range of help with the activities of daily life and financial support is a complex one. Shared histories, love and mutual obligations are at the heart of an interpersonal social solidarity that provides both emotional and practical support between family members. The difficulties arise when the older person’s needs become such that they require help over and beyond these ‘normal’ interchanges. The sud-den onset of dependency following, for example, a stroke, requires an imme-diate response of increased support from both formal and informal care pro-viders. However, when dependency develops more gradually individuals tend to hardly notice the slowly increasing need for help. This is particularly the case for spouses where mutual dependency is often a well developed life strategy. The reports from the 23 countries indicate highly variable rates of spouse care which cannot easily be explained by marriage rates, the relative survival rates of men and women or patterns of co-residence. In countries pro-viding directly comparable data it was reported that in Spain 12.4 % of family carers were spouse carers, in the Netherlands 14 %, in the UK 16 %, 21 % in the Czech Republic, 29.2 % in Poland, while in Finland 43 % were spouse carers. In trying to explain such large differences in reported rates of spouse care, the way in which the research was conducted plays an undoubtedly sig-nificant role, depending both on the definition of care used and also on whether the person interviewed was the older person or child or spouse carer. Thus a spouse carer might see himself or herself as being the main carer, while their child might also respond that they provide a lot of care. Hence,
EUROFAMCARE – Pan-European Background Report
18
comparing percentages of spouse carers or data on child carers does not nec-essarily indicate significant differences in practice.
This is a necessary preamble to reading this report since the point at which individuals providing care, or the authorities that offer professional care, define an individual as being in a caring role vary substantially. For each individual the point at which they recognize that they are a family carer varies. The man who can no longer count on his wife being able to cook safely, may find this the point at which care becomes a burden; while a child may find dealing with a parent’s failing memory the point of irritation and burden.
What is family care? From the outset of the EUROFAMCARE study its clear definition was essential since it had direct implications for selecting the sample of family carers for the 6 national surveys. Thus, although the UK is unique in having a legal definition of who is a family carer which is supported by 3 Acts of Parliament, in the context of this study family care was defined as
“Care and / or financial support provided by a family member for a person 65 years of age or over needing at least 4 hours of personal care or support per week, at home or in a residential care institution.”
However, given the massive social changes in terms of work, the role of women, the size of families, the more frequent occurrence of non-marital part-nerships with unclear social and legal obligations, divorce and the reformation of families, the growth of single person households and the varying role of friends and neighbours, it is not surprising that the portrait of the ‘typical’ family carer emerging from discussions amongst the partners was as varied as peo-ple themselves.
Nonetheless, certain trends in family care might be expected, in line with more general socio-economic changes such as towards a more urban, educated population and to greater economic resources, even if older people them-selves may not always take the largest share in this. Other factors likely to af-fect family care are better housing and home conditions, social and techno-logical changes that already make home and personal care easier (e.g. ready made meals, home delivery, washing machines, telephones, central heating etc.) and the potential for new technologies to make even greater contributions to home care in the near future (smart homes, robotics, telemedicine). These socio-economic changes have occurred and are occurring at quite different rates in the various countries.
Key Issues
19
2 Key Issues
2.1 Demographic Trends
Who precisely provides family care varies substantially, relating in part to demographic developments that have occurred in each country. Demographic trends, including declining birth rates and increasing life expectancy, have oc-curred throughout the 23 countries. However, the exact time at which the birth rates declined in each country vary, with Hungary being one country that ex-perienced a low birth rate several decades ago and Ireland being a country with a relatively recent decline. This aspect of demographic change should not be ignored since it provides an understanding of the ‘stock’ of kin and family members available to care in the population both currently and in the future. Other demographic changes that have occurred also have a substantive im-pact on the availability of family carers. These include the decline in marriage rates, the rise in divorce rates (excluding Poland), the decline in the size of households and the increase in single person households and patterns of ru-ral-urban and international migration. Each of these factors, in addition to pov-erty rates and the distribution of income between the generations and age groups, occurs with variations between the 23 countries (2003 The Social Situation in the European Union. European Commission. Eurostat).
Belgium has taken the demographic projections seriously and, recognizing the baby boom and subsequent low birth rate, set up a Silver Fund to meet the needs for pensions and care as conse-quences of the ageing population after 2030.
2.2 Legal Obligations and Family Care and the Role of the State
The legal situation regarding care obligations within the family varied widely amongst the 23 NABARES countries, as did the enforceability of the law. Given that the law represents an enshrinement of specific social attitudes and expectations and is constantly being modified, it was considered important to review the very different situation of family carers in the 23 countries, regard-ing both responsibilities and rights.
Legal obligations to care consist of financial responsibilities and duties to provide practical “care”, although the two cannot always be clearly distin-guished.
Moreover, legal obligations to care are different for spouses and children
� Spouses have ethical and legal obligations to mutual support and care
EUROFAMCARE – Pan-European Background Report
20
� Children’s obligations are not as clearly defined as those of spouses, if at all.
However, changing social patterns across Europe, with the increase of “part-ner” relationships particularly in Northern Europe without the legal ties of mar-riage, may lead to different care obligations between partners, as well as part-ners’ children, and the increase in divorce and re-marriage is creating new family networks with an associated lack of clarity regarding obligations and willingness to care.
Legal enforcement of family care duties
The enforceability of laws regarding family obligations to support dependent members, depended on the type of support specified, although almost no country could cite any case law examples where the practical duties of families to care were legally enforced. Portugal was the country that considered case law existed for the enforcement of care by families, while in Poland there were joint legal inheritance agreements on inheritance in exchange for care. Spain also cited that infringement to fulfil legal duties to assist could be punished with arrest from eight to twenty weekends under the Spanish Penal Code, though how often this was enforced in practice was not clear.
However, legal enforcement of financial support by children for their depend-ent parents was reported by many countries with regard to family contribution to payments for care (AT, BE, FR, DE, IE (recently repealed), IT, NL, PL, ES, PT, SI, UK). This is achieved by:
� “Means testing” of the dependent older person and / or spouse and / or children to pre-determine their financial ability to contribute to the costs of care, e.g. in the UK, an older person must contribute to the costs of care if they have assets above a certain level.
� Reclaiming costs of care via means testing of children’s “inheritance”, e.g. in France, the state is legally entitled to deduct the costs of residential care from the dependent older person’s estate on death
In both cases the family's financial participation in the costs of care, if they are able to, is ensured. The practical provision of care by family carers, however, appears to be legally non-enforceable and, though spouse care would seem to be part of the marriage contract, care by children and kin is essentially volun-tary.
In summary, amongst the 23 countries, primary legal responsibility for the care of dependent older people was as follows:
1. Spouse care obligation specified, financial and / or care (AT, FR, HU-until the change in regime, ES)
2. Child care obligation specified, financial and / or care (AT, BE, BU, FR, DE, EL, IT, MT, PL, ES, PT, SI)
Key Issues
21
3. State / local authority (CZ, DK, FI, LU, NL, NO, SE, UK)
4. Unclear or variable legal rights (IE, CH, HU)
In 1 and 2, the state assumes responsibility only if the family is unable i.e. there is an obligation on the part of the older person to show evidence of the family’s inability to care, such as no family members available, financial or so-cial difficulties etc. There is no state obligation or incentive to provide needs assessment, but the older person and the family may be means tested to as-sess eligibility for service.
In 3, the state, whether at national, regional or local level, assumes primary responsibility, using varied systems to encourage or support family carers in sharing care. This implies that services are provided according to need (needs assessment), with or without a financial contribution (the older person and / or family are means tested).
2.3 The Role of Family Care and Social Attitudes
Attitudes towards family care vary throughout Europe, but also within the indi-vidual countries, e.g. urban / rural, middle / working class. Although an attempt has been made to classify these variations in attitudes towards family care, there is really a spectrum which is often also related to levels of formal service provision for the older person.
� High social expectations to provide care, no formal recognition FR, EL, HU, PL, ES, PT
� High social expectations to provide care, increasing formal recognition AT, DE ambivalent, IE, IT, MT, NL
� Low social expectations about family care, no formal recognition BU, CZ, DK, LU, SI, CH
� Low social expectations, increasing formal recognition BE, FI, NO, SE, UK.
At the individual country levels however, wide variations in the approaches to family care exist, exemplified even within the Scandinavian countries with their traditionally high levels of health and social care services.
The Danish approach is to focus on the continuation and expansion of ser-vices to meet the increasing demands of an ageing population, with little rec-ognition of the role that informal family care does or could play in future plan-ning. This approach reflects the similar policy for care of children, where high levels of female labour market participation are supported by high provision of public infant and child care services.
Sweden in contrast, despite similarly high levels of women working outside the home and of service provision for older people, is experiencing a “re-
EUROFAMCARE – Pan-European Background Report
22
discovery” of family care and has recognised the value of and need to support family carers, in combination with good and adequate services.
Many countries would envy the efficiency of Sweden where the development and implementation of a 3 Year Action Plan (1999-2001) stimulated Local Authorities to develop an infrastructure of services targeting family caregivers, e.g. by setting up caregiver resource centres offering training, counselling, support groups, respite care, in-formation and resources for family caregivers, including day care programs for their disabled family members.
Interestingly, in Norway, where very detailed information is available from specific projects on who undertakes different caring tasks for the support of dependent older people, women in paid work are reported to provide more in-formal care than non-working women. Nevertheless, the role of the Norwegian family carer is considered to have a supervisory nature rather than providing regular “hands on” care, due to high levels of service provision, although the Action Plan for the Elderly specifically underlines “the importance of taking care of and supporting the caregiving ability of families.”
In Finland a significant part of daily activities (cleaning, shopping, laundry etc.) for older people living at home, including the very dependent, is undertaken by relatives either with or without public support. Without family carers there would be a lot more pressure for institutional care and there are indications that older people would like to give more responsibility to relatives for their care. The importance of family caregiving has been noted in Finnish society by policy makers.
The administrator appointed by the Finnish Ministry of Social Af-fairs and Health, recently (March 2004) made a proposal contain-ing 16 recommendations involving family carers’ well-being, pay and leisure as a way of developing the status of carers as part of social and health services. The aim is to give the family caregiver the status of a municipal worker, with these changes being intro-duced gradually and completed by 2012. Services are mainly pub-lic with the municipalities contracting to private agencies to fill the gap between demand and supply.
In summary, the “Scandinavian model” of care, based on a high level of ser-vice provision, in fact displays 4 different examples or models of care for older people when viewed from the perspective of the family carer.
A quite different model is being developed in the UK, Ireland and the Nether-lands where family carers are being recognised as a group of citizens with special rights.
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The UK is unique in giving legal recognition and associated rights and services to family carers, enshrined in the Carers’ (Equal Opportunities) Act 2004.
At the other end of Europe, the “southern European” or “family model” of care, exemplified in EUROFAMCARE by Portugal, Malta, Greece, Italy and Spain, also displays broad differences in developing services and support for older people and their family carers in response to demographic and social changes. Traditionally, Portugal has many women in the paid labour market and as a result makes more use of residential and home care services for very depend-ent elderly people; this contrasts with Greece with a low labour market partici-pation rate of women, a low use of residential and home care services and a turn to using migrant care workers by those who can afford it.
2.4 The “Work” of Caring
2.4.1 Family Carers
Family carers were rarely considered in the 23 countries as part of the paid labour force, with the main focus of interest and data being on the potential and actual impact of family care on labour market participation. Nonetheless family carers do provide their labour, mostly unpaid, to support the dependent older person; the supply, availability and willingness of individuals to act as family carers is critical in understanding the long term trends in labour provi-sion for care work. The difficulty revolves around the unpaid and unrecognized nature of domestic work – a problem faced by economists and statisticians. Is family care and domestic maintenance part of the national economy or not? Where this work is undertaken by paid persons it is counted as falling within the labour force, though not when unregistered.
As might be expected, the Swiss have studied the economic value of family care work, which they calculated to reach between 10 and 12 billions of Swiss Francs, exceeding the cumulative spending on both home care services and residential care homes.
Thus the rate of women’s participation, or non participation, in the labour mar-ket is often a dimension of labour availability for care work. The critical issue in the labour market for care work lies in whether the individuals providing do-mestic and care work are officially paid with national insurance and tax contri-butions or not. The debate also revolves around the ‘work’ people do to sup-port one another, as part of normal social exchanges, and that which goes be-yond these ‘normal’ interchanges to become defined as ‘work’. Only a few
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countries have provided any estimate of the total amount of time and thus ‘work’ provided by family carers – Norway reports that care for those over 67 years of age takes approximately 49,000 man years per annum. Yet this in-volves all kinds of care and rarely in the national reports or literature is suffi-cient distinction made between ‘normal’ care and support, and the labour in-volved when people become very dependent. Nonetheless data on dependent older people shows that in many countries (AT, BE, IT, CZ), 70-80 % of care was given by family carers. This contrasts with data from Denmark that shows that less than 55 % of older people get family care support.
Data from national studies on the proportion of the population giving care are not very helpful for comparative purposes, since the nature of this care, the size of households or which ages are counted as being potential family carers varies widely, ranging from the whole population to those aged 16 or 18, with variable cut off points, e.g. aged 65 or age 74. An example of this kind of diffi-culty in comparing data can be seen when examining the data on Portugal where 2.3 % of the population are reported as caring for an older person, Spain, where 5 % of those aged 18+ are reported as providing family care to a dependent older person, equivalent to 12.4 % of households, Switzerland, where 23.1 % of the population are reported as caring for someone aged 65 and over, and the Netherlands, where 18.8 % of the population 18+ (2 million) report caring for someone 64 years and above. Some of these differences in rates of family care between countries are frankly counter-intuitive.
The national reports provide indications that even within countries there are often massive variations in the amount of family care provided; UK, Ireland, Italy and Spain report such significant variations, e.g. more in the South than the North of Italy, and more in Northern England than London, while other counties report large urban-rural differences. Thus the difficulty does not lie in the accuracy of national data per se but the lack of comparability in studies and the criteria used to measure family care.
2.4.2 Characteristics of Family Carers
Given some of the specified problems in defining family carers, what does emerge in many reports is the predominance of women, whether as child, sister, spouse or friend / neighbour carers. Though the rates vary, overall ap-proximately two thirds of care5 is provided by women. However, where data are available for care for the most dependent, the numbers of women carers rises, e.g. in Italy, the proportion rises from 66 % to 81 % for heavy care, while for those receiving allowances, normally awarded for the care of the most heavily dependent, the figures from Luxembourg and Spain show figures of 94.2 % and 83 % women respectively. In Germany, amongst the terminally ill 81 % of family carers were female: wives, daughters or daughters in law.
5 66.33% BE; 64% CZ; 75% FI; 75% PT: 69-74% MT; Women give 2.5 x more care than men NO.
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Amongst these, 32 % were also in paid employment with the proportion for daughters being 61 %; 87 % of them additionally were responsible for their own household. This kind of pressure on women inevitably had repercussions on their own mental and physical health and this is discussed later.
Yet where care is provided by older people to each other, then there is a greater gender balance: Poland and Switzerland reported equal proportions of male family carers in the 50+ age groups while the UK reported no gender dif-ferences in family care for co-resident carers, though women do more care in another household in both Switzerland and the UK. In Italy, 10 % of family care was provided by people who were themselves over 80 years of age.
Although in many countries children, especially daughters and daughters in law provide a large percentage of family care, e.g. nearly 75 % were child car-ers in Malta, there were large variations. In Hungary, daughters constituted 11.3 % and sons 8.7 % of all family carers compared to 37.1 % daughters and 20.9 % sons and 15.5 % grandchildren in Poland.
Social changes in marital and family relationships in Europe are often as-sumed to have implications for the availability of family carers. In the case of spouse versus other forms of non legal partnership, the data from the national reports was not clear; thus no valid reflections can be made on this issue in this report. Demographic differences between countries may account for some of the variation in who cared; sibling care, especially by sisters, was pointed out to be important in Slovenia. However, in examining the variations in who provided care in a range of countries where data are available, the role of the wider family, neighbours and friends, was evident. In Spain, relatives other than parents, spouses and in laws provided 14 % of care, while neighbours and caretakers provide 5.6 % and friends 4 %; in Hungary in rural areas 19.2 % of older people relied on friends and 34.4 % on neighbours; in the Czech Republic 16 % relied on friends and 10 % on other relatives while in Belgium the wider family cared for 17 % of dependent older people needing care while non-family carers were responsible for 13.3 % of care.
The age of the carer, the current state of the labour market and women’s par-ticipation in the labour market all appeared to have a direct influence on those who both worked and cared. There were a number of countries marked by the high rates of labour market participation (80 %) for women until the age of 55 years, including CZ, DK, PT, SE and FI. This was reflected in the fact that a large proportion of carers were employed; however, again one should be care-ful as the degree of dependency of those they cared for was often less than in other countries. Thus in Portugal at a certain level of dependency it appeared that older people went into residential care, while in Sweden and the Czech Republic there were a variety of forms of residential support for those who could no longer easily be cared for at home. As suggested, the percentage of those using any and all forms of residential care has to be considered in order to understand the ability of family carers to hold down full time jobs. In addi-
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tion, the hours given to care must be carefully examined, with the suggestion that working carers probably give fewer hours to care. This compares with fig-ures for Spain where 22 % of family carers were employed (36 % part time and 64 % full time), or Poland where a third worked and cared.
In several countries family carers were reported as being more likely to be housewives, pensioners or unemployed (BE, EL, DE, ES). Germany reported that civil servants, the self employed and the salaried were those in the labour market who were most likely to combine work with care, though overall those caring for older people without dementia were more engaged in the labour market (30.9 %) than those caring for a person with dementia (25.3 %). In Switzerland, 33 % of the self employed provided care, while 21.8 % of the un-employed did so. Ireland brought some interesting data to show that despite the huge increase in labour participation rates for women (50 %), they contin-ued to do the same amount of caring as the non-employed. Such data sug-gests again the difficulties of unravelling the concept of care. Those who work may be far more inclined to notice that they are also caring than those who do not work. The decline in rates of employment for women, especially in the Eastern European countries, has implications as to the availability of people to care, e.g. in Slovenia, though also in France. Yet internal and external migra-tion, e.g. in Bulgaria, Hungary, and Greece may leave many older people with fewer available carers.
The economic aspects of family care are also reflected indirectly in the infor-mation from Austria that amongst the 40 % who were employed and cared, those with low status jobs were more likely to undertake work and hands on care. In Italy, family carers tended to have more available income than non-caring households yet 60 % were unhappy with their economic situation; these data probably reflect the pooling of resources by the family carer and older person in a common budget.
There are often considerable details on the average age of carers – yet as al-ready indicated the (self-) definition of family care makes such data problem-atic in a cross country review.
The trends observed by national experts are important in deciding on the fu-ture availability of family carers, all other matters being constant6. Several countries perceived a trend in the decline in willingness to provide hands on care especially amongst the better educated and those with better jobs (AT, DE, NO) and this was also noticeable among women, where the large in-crease in the numbers working and / or the availability of long-term care insur-ance (LCI) allowed many to retreat from care (FI, IE, DE, MT, NL). Belgium noted the increased mobility in society, making family care less available, while Hungary and Malta noted the trend that older people and family carers
6 Of course they are not constant. Thus in Sweden the decision to support family carers may in-
crease the numbers of people offering care to dependent older people.
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less often share a common household. A number of countries commented on the increase in the numbers of male carers (HU, EL, IE, IT, MT, SE) and Nor-way and Sweden noted that the total amount of family care has increased though the hours spent has decreased, which is in line with the provision of more care services. Finally, some authors commented on the changes in atti-tudes amongst older people; some perceived their families as less willing to care (BE) and others, including the Netherlands, suggested that there was evi-dence that the better educated preferred public and private services rather than help and care from their kin.
2.4.3 Is Family Care ‘real’ Work?
Studies from various countries provide some perspective on the number of hours for which family carers worked to support dependent older people. In Portugal, 68.3 % of family carers provided more that 4 hours per day and 56.6 % provided care every day. In Ireland, the breakdown of hours provided by family carers showed that 60.3 % worked 1-19 hrs, 13.4 % - 30-49 hrs and 26.7 % more than 50 hrs per week. Luxembourg, which provided a detailed breakdown for the hours of care given to dependent people of all ages indi-cated that the young disabled needed most care followed by the oldest age group (90+) and that overall 35 % of dependent people needed in excess of 24 hours per week. In the Netherlands, the average amount of care amounted to 17.9 hours per week, including domestic help, psychosocial support and per-sonal care. These indicative numbers suggest that taking on the care of someone means for many people to invest a lot of their time and perhaps a half of all carers have, effectively, the equivalent of a half time ‘job’. For the most dependent, including, for example, those with dementia or those at the very end of life, the hours needing to be spent in care rise substantially. Unlike the care of children, family care of dependent older people cannot be pro-grammed precisely. The gradual nature of increasing dependence is the usual scenario, though not even this is predictable and age related decline in func-tional ability may include significant periods of decreased or increased de-pendency (Robine, Romieu, 1998). The lack of ability to ‘programme’ the work needed is one of the characteristic problems of family care work with older people and, indeed, care from service providers7.
Another aspect that reflects on the nature of the work of a family carer is the issue of its consequences to their health and well being. As already discussed, the levels and types of care provided in countries varies, but given that in many only inadequate services to support both older people and their family carers exist, what does emerge widely from the reports is that the provision of care has both physical and mental consequences. France reported that family carers had double the risk of depression than in the general population, a find-ing that is supported in other countries where depression and psychological 7 Hence the interest in discussions on the cultural as well as the health aspects of dependency.
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burden were noted as being very frequent. In Portugal, where depression was also an issue among family carers, the report also indicated that needs and problems vary by income levels, with leisure being more of an issue for the better off and financial help for the worse off.
Also commonly more frequently reported amongst family carers than for the general population were physical problems that were consequences arising from care. For example, the German report states exhaustion, pain in arms and legs, bad backs, heart trouble and severe stomach pain. These symptoms were more pronounced amongst those caring for the cognitively impaired. So-cial isolation and the inability to participate in normal family and social life, mentioned in the Slovenia report, is undoubtedly a widespread phenomenon. For care-providing ageing spouses, fears of what would happen if they died or could no longer manage, was a specific issue mentioned in the Danish report, but probably a common theme for spouse carers in many countries; the Neth-erlands noted that spouse carers were less likely to use services, though car-ing full time, while Norway reported health risks for older people providing long term care for spouses with dementia.
One aspect of family and professional care that helps in understanding the na-ture of the work and particularly its emotional consequences is that which con-cerns abuse. Most countries have no or very little data on the issue8. Slovenia reported research that found a staggering 50 % of older people were abused by their children, with family members or relatives being responsible for three quarters of incidences of abuse and the explanation being found in the exhaus-tion of family carers, although 10.9 % were also abused in the institutions where they lived. The Scandinavian countries provide figures for elderly abuse that vary from 1 % to 8 %, with abuse more common in urban areas. In one study in Germany, 10.8 % of older people, disproportionately older women, reported violence against them, though psychological maltreatment and financial abuse were more frequent. In the Italian report, reference was made to recent re-search monitoring 2,500 people aged over 60 in a number of European coun-tries; Italian older people were those reporting most loneliness and neglect for which they held their children responsible9. Domestic violence is generally hid-den.
A study in the UK indicated one in three old people were psychologically abused; one in five physically abused and the same number has their savings inappropriately used; more than 10 % are neglected and 2.4 % sexually abused. There is also only limited data on abuse of older people in residential care.
8 In addition, data is often not comparable since the research definitions used vary.
9 Like dependency, this is often a matter of cultural and individual definition.
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In Italy pioneering projects in Turin, Rome, Milan and Genoa sup-port elderly victims of abuse as collaborative ventures between municipal authorities and local voluntary agencies.
Germany and Italy point to the fact that there is also inadequate data on abuse by older people against their family carers.
What is important to underline is that interpersonal relations may become very tested when dependency becomes a characteristic within the relationship. In-terventions in such situations require a well developed and proactive psycho-logical service and it may be more effective to provide more respite care than to try to alter the relationships between the family carer and older person.
The Czech Alzheimer Society started a new project, “granny sit-ting”, that provides family caregivers with regular respite.
In the general framework of training for all carers, the issue of dealing with an-ger, frustration and difficult interpersonal relations should also be confronted.
In Malta, where the Catholic church is important, two church-based organizations give training called “Care for Carers” de-signed to reduce stressful situations, improve communications, as well as provide care in a more effective and efficient manner.
In discussing the issues of the hard and difficult work of family carers it should not be forgotten that many obtain satisfactions from their caring work; interest-ingly this aspect rarely emerged in the research quoted in the national re-ports.10 The UK was one exception to this; studies which included minority ethnic groups indicated that the extent of care giving satisfactions outnum-bered the difficulties with the dynamics of the relationship between care giver and older person being the key factor.
The value arising from the recognition that the work provided by family carers often has real health and social costs for them, lies in considering which ser-vices can best relieve and support them, e.g. in confronting depression, in re-ducing the physical toll and social isolation. Another aspect is that some of the same issues may also arise when considering care work conducted by profes-sionals; learning specific skills and having appropriate practical and psycho-logical support may play significant roles in helping both family and profes-sional carers.
10
This is likely to be the result of consistent value judgements by researchers who focus on burden
rather than satisfactions.
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In Slovenia, the Anton Trstenjak Institute provides intergenera-tional communication programmes so that family members are trained to better understand older people. This has several bene-fits; the quality of life of older family members is improved, eve-rybody is more pleased due to better family relationships and younger generations become familiar with old age, the first step in preparing for their own ageing.
One such form of support that plays a highly variable role in some countries is that of family carer support groups. While some groups are particularly con-cerned with advocacy for their rights and the conditions under which they work, many are also important in providing psychological and practical support to one another, e.g. the Alzheimer Society or the Federation of Senior Citizens Organisations – BAGSO – in Germany. As discussed below, such groups may be supported and encouraged by national and local governments.
2.4.4 Reciprocity in Family Care Work
Property, savings and life time exchanges between the older person and the family carer have to be taken into account when examining the willingness of individuals to take on care. While not the primary motivation from the perspec-tive of the family carer, it may still play a significant role in the reasons people feel there are obligations to care, though there is limited research on the sub-ject. Research in Norway indicated that despite the fact that there are consid-erable transfers from older people as inheritance, pre-inheritance and gifts, this did not generally influence the amount of care given to older parents by children. If parents are in need of nursing, previous practical help from parents to children, including child care, resulted in more nursing care by children. Overall older people gave more help and economic support to the younger generations, compared to the help they received. The German report stressed that moral obligations and financial considerations are not mutually exclusive in family care. In three countries, Belgium, Denmark and Finland, property and savings were said to play no part in family care. In Spain, 63 % of family carers indicated that the older person gave them no economic rewards, 23 % regu-larly received compensation and 13 % occasionally; but the overall costs to the household of providing care were substantial, especially those with a medium-low economic status, since pensions are low and do not even cover the costs of care.
Overall in 15 of the country reports property and economic transfers were stated as playing some role in family care. In Austria, one study showed that 72 % of family carers considered transfers to be important and only 28 % felt that inheritance plays "a negligible role” in inter-generational relations. In Bul-garia, Poland and Italy, inheritance was important and if a family took the older person’s property and then did not provide care the state intervened. In three countries, Hungary, Slovenia and Poland, explicit mention was made of the
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value of the older person’s pension to the carers, given the high rates of un-employment. Slovenia, Ireland and UK mentioned that older people often want to be able to pass on their property to their children, leading to reluctance to seek other kinds of care solutions or support which would involve them selling their assets.
With reference to long term trends in willingness to care, it is necessary to consider if such exchanges and inheritance are likely to continue to be impor-tant. It may be presumed that where the older person offers a scarce eco-nomic resource this aspect will continue to be significant, though much less so where their children have their own resources. One hypothesis might be that older people either with resources or, as the Portuguese and Norwegian re-ports indicate, who have given a lot of time and energy to the practical support of their children, are more likely to receive care.
2.4.5 Professional Paid Care
In discussing services to support older people and family carers, the availabil-ity, training and qualities of all those employed to work in the care sector need to be considered, since they provide the context in which family carers can genuinely rely on support and help in their work. Care work in both residential and home care services is overwhelmingly being provided in the public sector. Nonetheless the growth of organised private sector services was reported in Austria, Finland, Germany, Greece11 (very limited), Ireland, Italy, Luxembourg, Netherlands, Norway, Poland, UK and Slovenia. While it is probable that these private services are more used by the better off amongst older people and their families, few countries reported large differences between the public and private sectors in terms of their attractiveness to care workers or in terms of their ability to recruit and retain care workers. Of particular interest are those countries that reported few problems in recruitment and retention of care workers in either the public or private care sector, e.g. The Netherlands, Bul-garia, France, Luxembourg, Malta, Poland, Portugal. Others, like Belgium, have had a problem and are attempting to improve the supply of nurses and care workers by improving working conditions and pay, while in Denmark simi-lar attempts are being made by improving training and attempting to attract more men into caring jobs with older people. All these positive examples are important since they suggest that there is nothing inevitable about the difficul-ties reported in so many countries in recruiting and retaining care workers for older people.
What are the main difficulties reported in the national reports? These include low pay in Finland, Austria, Greece Hungary, Ireland, Poland, Portugal, UK (especially unqualified staff); the lack of staff leads to unacceptable shift work
11
Reference here is to organised services rather than the growth of migrant care workers who are not
normally organised into a service.
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and overtime in Austria, Slovenia and Germany, while Poland believes this is a future problem they will face. The low prestige and tiring nature of working with older people was commented on for the Czech Republic, Germany, Greece, Hungary, Italy, Ireland, Sweden, Switzerland and the UK. The lack of a real career and promotion opportunities was commented on by Ireland. Even in Norway there was a high turnover amongst care workers in the urban areas. The predominance of women in care work was a feature of every country – a characteristic that is nearly always associated with lower pay and prestige. In the Netherlands, professional care workers in residential care have increas-ingly limited time for every patient, due to budget cuts. Increasingly volunteers and family carers are needed to provide care in residential and nursing homes.
Thus one of the critical issues facing most countries is how to improve the status, conditions of employment and attractiveness of working in the care sector for older people in the many countries where care workers are often undertrained and overworked. This is a difficult issue given the fact that public budgets in most countries tend to be limited, unskilled and semi-skilled labour is often readily available and cheap, while the perception and often the reali-ties of work with older people is that it is depressing and hard. Clearly, as some of the 23 countries have managed to improve the status of care work, there are lessons to be learned about how this may be achieved.
One way forward is training, in combination with the development of a ca-reer structure for care workers. In turn, this requires that all services intro-duce quality standards.
This may be one arena in which interventions from the EU could be a positive influence, e.g. the promotion of minimum standards in care work and ensuring that some EU funded training schemes are devoted to care work. Several countries noted that in private services care workers were often less trained than in the public services.
In Portugal training the long term unemployed to work with older people in a social support service was developed.
In Hungary, with its long-term low birth rate and fewer children to care, NGOs have been active innovators. The Budapest Centre of the Hungarian Maltese Charity Service linked a two year health and social training to the employment of disadvantaged young girls and boys living in poor family circumstances with emotional and family deprivation. On graduation the young people took jobs in care and nursing for older people where they also functioned as quasi grandchildren. The same NGO has also supported the development of networks of voluntary and neighbourhood carers to cope with age-related disability.
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However, caution is required in extrapolating from these suggestions and ex-amples; the French report indicated that unless there are clear advantages in terms of employment and promotion for those with qualifications, and while public and private bodies continue to hire the unqualified at similar rates to the qualified, individuals may perceive no real advantage in gaining qualifications.
The modernisation of services and institutions represents an important way of moving forward in making care work more attractive; thus, introducing new technologies where possible and training both family carers and profes-sional staff would appear to be a positive step forward. Given the under-funded nature of many public and private care services this may not always be feasible, but must be considered as a possible strategy at national level.
Making the conditions of employment more attractive is another device to attract and keep care workers; genuinely flexible forms of employment12 from the perspective of the employee may be attractive to some individuals. Swe-den reported using increasing numbers of part time workers in both home and residential settings, reflecting contradictions between stakeholders – what is good for workers may not be good for older people, e.g. with respect to conti-nuity of care.
In Belgium a federal initiative Integrated Services for Home Care (GDTs) help family carers by organizing multi-disciplinary consul-tation and by helping them to draw up a realistic care plan that specifies the tasks of each (formal and informal) carer.
Another area for possible improvement lies in changing attitudes towards older people and perhaps of older people towards care workers. The experiences of possible attitude changes in Austria, Germany and Hungary, where young men may work in care settings for older people instead of doing military ser-vice, would be interesting.
In Denmark the attempt to make care work more attractive to men is one strategy that needs to be monitored.
2.4.6 Migrant and foreign Care Workers, legal and illegal
De facto solutions to the recruitment of care workers for older people are being found in 13 of the 23 countries (AT, CZ, DE, DK, EL, IT, LU, NO, PL, ES, PT, CH, UK) by the use of migrant and foreign care workers, as domestic, care or nursing personnel. As is evident, this solution was being used in a wide range of countries in terms of both income and welfare systems. There were no data 12
Marrying the interests of services, e.g. the need to organise shift work and 24 hour coverage, can
be done in conjunction with the wishes of employees for flexible and/or part-time employment.
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for France, but migrant workers were apparently important and for Ireland mi-grant workers were important in the nursing sector. Belgium and Sweden pro-vided no data. The countries reporting that migrant labour was not important in care work were FI, BU, MT, NL and SI, and only a few reported that foreign born people were less likely to be employed in health and social services; The Netherlands pointed out that a significant impediment for entering this part of the labour market is the requirement for higher education and the poor com-mand of the Dutch language. Recently, in the Western, urbanised part of the Netherlands more migrants are working in the lower care jobs.
One of the difficulties associated with migrant care workers is that though many may be more educated than local care workers, they are rarely trained in care work per se and may have language problems. Many governments, sim-ply by not developing public services and by not having active policies towards the recruitment and legalisation of foreign migrant care workers, are conniving with the current situation which leads to exploitation and a lack of control13. Ensuring their legalisation, training (including language), and their incorpora-tion, where feasible, into a caring career, is likely to be important for the com-ing years until attitudes and practices change substantively in many of the countries reviewed.
2.4.7 The Voluntary Sector
A large number of countries had and have sought to develop volunteer ser-vices to help with the care of older people and indirectly for family carers. Aus-tria, France, Belgium, Bulgaria, Hungary, Ireland, Finland (1 % of all care), Germany, Greece, Italy, Malta, Netherlands, Poland, Slovenia, and the UK all reported that volunteers were important in caring for older people, while Swe-den and Norway specifically mentioned the importance of volunteers but not for hands on care. One outstanding example is Hungary, where 70,000 NGOs have developed in the past years, 13 % being in the health and care fields. Here volunteers work at lower wages than employees but undertake hands on care. This contrasts with the situation in most countries where volunteers do not undertake a lot of hands on care, but provide important auxiliary services such as transport, accompaniment, social support etc. In a number of coun-tries, family carers’ self help groups are also important in terms of offering practical care support.
13
It may well be argued that the private solutions adopted by the middle and upper classes by em-
ploying migrant care workers contributes to the lack of political concern with the general situation of
family carers.
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In Germany the Department for Social Work in Wiesbaden (Hes-sen) runs a course qualifying people as "voluntary senior citi-zens’ companions" designed to lessen the burden of care and give support to family carers in need of a few hours of free time.
In the Netherlands the national organisation for Voluntary Pallia-tive and Terminal Care (VPTZ) with 180 local VPTZ-organisations has a well-developed training course for volunteers who are pro-viding palliative and terminal care at home and in hospices to re-lieve family carers.
In contrast, volunteers played a very limited role in both Spain (0.1 % in care for older people) and Portugal. No data from national reports indicated whether organized volunteering substantially relieved family carers, although in Ireland, 12.5 % of all volunteers provide services for the sick and older people.
2.4.8 The Future of Care Work
The above analysis suggests that the care of older people will continue in many countries to rely heavily on family carers, supported by professional care workers and this is probably in line with the wishes of some family carers who want to care. The overwhelming majority of public budgets can currently not bear the full costs of developing a system of comprehensive care for older people through publicly provided services, especially since future predictions indicate that the demand for care is likely to increase. Thus ensuring that fam-ily carers are supported by professional care workers is critical, as are policies and practices that compensate family carers for care undertaken by ensuring that they retain a good quality of life and security in their own retirement. Both these aspects are critical elements to be addressed in policies for family car-ers.
In Ireland the development, promotion and adoption of the Carer’s Charter marks an attempt to recognise publicly the work and the rights of family carers.
Family carers’ recognition can be further promoted through the development of training and changes in attitudes that will ensure that all care workers learn to perceive family carers as vital members of the care staff, with rights to leave, respite care, advice, information and training.
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The German Federation of Advice Centres for Older People and Family Carers (BAGA) published a manual for professionals on how to give advice and support to family carers of older people suffering from dementia, including practical training, support groups for older people suffering from dementia, advice and counselling in domestic care environment, volunteer services, café for family carers and Alzheimer-dancing-café sessions. The reader also contains comprehensive information on family caring and relevant legislation.
The systematic training of family carers could be another important develop-ment, particularly in creating professional attitudes towards care work and en-suring good standards amongst family carers and safeguards for their own health and well being, although their parallel need for adequate support ser-vices in the provision of care should also be emphasized.
In the Spanish autonomous province of the Canary Islands, the “Programme for the Elderly at Risk” includes support to carers offering training activities to 100 % of carers and community sup-port plans for self-help groups and associations.
Such training may also provide a future supply of care workers who after quali-fication may wish to work in this sector. Another important resource, not fully explored in most countries is the use of more part time care workers in both home and residential care settings.
A further development in the coming years will be the increasing numbers of older people from ethnic minority backgrounds. A number of countries have already developed services for them and some have also recognised the needs of migrant caregivers.
In Germany, concern with migrant family carers is evident in a number of courses being run throughout the country, e.g. a care-giving course in Wiesbaden is offered to Turkish migrants in Turkish and German.
2.4.9 New Technologies
New technological advances have neither been fully developed nor had yet an extensive impact in supporting care work with older people. This is partly due to the low levels of computer literacy amongst many older people, including family carers, and partly due to the difficulties of using new technologies in old homes. The ‘smart’ house is still a number of years from real implementation, though in countries like the Netherlands alarm systems and ICT-technology
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are becoming standard equipment. The Italian report indicated that those who could afford it were paying for expensive new technologies including security alarm systems, video-telephones, mechanized shutter locks, tele-medicine de-vices, mechanised doors / window openers, data networks (for rapid shared access to the Internet), bedroom intercom, visual and auditory signals, remote control apparatus of certain functions via phone. A number of countries includ-ing Finland, Germany and the UK are working to develop gerotechnology, e.g. locomotion devices in / out of house, assistive technologies for eating and other activities of daily life, security, e.g. timers for lights, locomotion recogni-tion, security telephone, doorbell alarm, night alarms that wake the family carer if the older person moves from their bed in the night etc. Many countries are seeing the introduction of information and counselling systems designed to be used by family carers and professionals, whether run by local authorities, NGOs or family support groups.
In Sweden a telematics intervention programme (ACTION) has been devel-oped to support family caregivers of older people. The service consists of edu-cational caring programmes, video phone facilities for on-line communication with other carers and a call centre staffed with professionals an access to the Internet. The ACTION service has so far covered 40 families who are very sat-isfied with this type of support. (Magnusson 2005)
However, cheap and effective solutions such as the Hungarian alarm system between the older person’s house and a neighbour are probably the closest many older people and family carers currently get to using and accessing ‘new’ technologies!
Public investment in all forms of gerotechnology is important for the work of family care and the support of dependent older people14. However changes in mainstream developments can also have important implications for family car-ers. Thus, as both the Greek and French reports point out, cheap mobile phones allow family carers to be in constant communication with the older de-pendent person. Market penetration of most new technologies aiding family carers will initially be limited in many of the 23 countries due to low incomes. As in all innovations there are both benefits and potential abuses in the use of IT in care work, e.g. the ethical dilemma of constant observation.
2.5 Public Investment in Care and Family Care of Older People
2.5.1 The Right to receive Care
The right to receive care in times of illness, either short or long-term, is now agreed to be a fundamental right within the EU, enshrined and reflected in na-tional laws and the EU Social Charter. Whilst the 23 NABARES countries all
14
The EU is supporting a number of R&D initiatives that may help with care work e.g. smart toilets.
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provided a basic health care system at the hospital and primary care levels much wider variations in the provision of social care services to older people exist, particularly in regard to home care services and whether these were provided as a statutory right, depending on need (degree of dependency) and financial situation (means tested). The increasing demand by ageing popula-tions in Europe for long-term care for chronic conditions causing disability and dependency emerges as one of the major trends examined in the NABARES reports, with focus on the main issues of who provides care, where is it pro-vided and how is it funded. There are significant inequalities and fragmentation in care provision as long-term care may be provided by either health or social service sectors or both. All 23 countries undertook some responsibility for the care of dependent older people, although there was great variation in:
� The degree of public responsibility
� Limited, e.g. only for the most disabled, those without financial means, and without family support
� According to need
� The type of public support available
� Financial support to the older person or the family carer
� Services to the older person
� Services to support family carers
� Length of time for which support is provided, e.g. Czech long-term care units put a limit of months on residence, in Greece the Urban Workers Fund limited public funding for nursing or clinic care to 6 months.
The public sector is increasingly funding and arranging the financial coverage for care but devolving at least some aspects of hands on care to others, be they voluntary, private or family carers, e.g. Hungary has seen a major expan-sion in NGO provision, the Netherlands leaves it to the older person to arrange what type of care they seek.
2.5.2 Approaches to Carer Support
How can family carers be supported to continue providing care at home for their dependent older people without adverse effects on their own physical and mental health or without long term consequences for their income?
In the NABAREs reports the following areas were examined:
� Financial support including payments / benefits (services in kind and services in cash), social and accident insurance and pension contributions
� Services to the older person
� Services to the family carer
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As discussed in section 2.2, the variations in social care provision in the 23 national reports appeared to depend largely on whether the state took primary responsibility for the care of dependent older people, or only by default when there was no or inadequate family to care. In the latter case, seeking help from the state automatically implies a “deficiency” in the socially preferred form of family care, which in itself is perceived as reflecting an older person’s “value” to society, earned by having and bringing up children within society’s expected norms and values. In general, countries where the state takes primary respon-sibility for care of dependent older people also have higher levels of service provision (DK, FI, LU, NL, NO, SE, UK), but not exclusively, since several countries in which children have the primary responsibility for care still have quite high levels of service provision (AT, BE, BU, FR, DE, MT, PT).
2.5.3 The Rights of Family Carers and their financial Recognition
A number of countries have introduced public financial payments in the form of benefits or long term care allowances to help with the care of the dependent. These may be paid either to the family carers who provide the care as in AT, BE / Flanders and Brussels, CZ, FR, HU, IE, MT, NO, PL, ES, PT, SI, SE and UK, or they may be paid to the older person to pay the person providing the care service (NL and DE), or in some cases to both. Thus in France the Na-tional Allowance for Dependency (APA) is paid to 605,000 means tested older people; however, in some cases family carers may also receive a salary.
In Germany the long-term care allowance is means tested and taxed and older people needing care can choose to take the cash (71 %) and organize care themselves, or take it in benefits in kind and use professional services (12 %), while 15 % combine benefits in kind and in cash.
In wealthy Luxembourg all those needing help are covered by de-pendency insurance, the amount varying by assessed levels of need. A dependent older person receiving a nursing allowance (23.85 euros per hour) can use up to 7 hours of care per week to pay a family or informal carer; if 7-14 hrs are needed, the service networks must provide half the hours, if more than 14 hours per week are needed they are entirely provided by help services. An-nually the dependent older person receives a double nursing al-lowance to finance respite care and give the family carer time for recreation.
In several countries the amounts actually paid are so low as to not even cover the direct costs of care, e.g. Malta, Hungary.
There are considerable debates on the benefits of paying family carers directly or the older person, with pros and cons for both arguments; paying the family carer directly may not allow flexibility and change in care arrangements and
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also runs the risk of devolving all care responsibilities onto a single carer, whereas payments to the older person, although seemingly promoting more choice in care, may not be given to the family member providing the most care.
In many countries there is no public and statutory recognition of family carers (ES, PT, EL, PL, MT, BU) so that there is no entitlement to any kind of finan-cial payment, to leave from work or for respite care. In practice, even in these countries some reported that those family carers employed in the public sector did have some rights to paid and unpaid leave, though these rights were virtu-ally never exercised in the private sector (PT, SI). Typical of this situation was Portugal where public employees have the right to 15 days per year under the cover of ‘family medical certification’ to care for an older person, but in the pri-vate sector such leave is only available for the care of those under 10 years of age.
In other countries such as Austria and Germany, where increasing recognition is being given to the reconciliation of work and caring through such policies as care leave, reduced hours and the right to re-employment, there were com-ments that despite the rhetoric, family friendly policies are rare (1 % of compa-nies in Austria) and mainly for those with scarce skills. In Germany, new rights were introduced for working carers to have leave for short periods of up to one year, with or without wage adjustment, but only a few large Companies allow flexible hours or job sharing (AT, DE). In Sweden, the Care Leave Act (1989) ensures that those under 67 years and still in the labour force have the right to paid leave for 60 days to look after a dying family member.
A number of countries, even those without support services for family carers and very limited public recognition of their role, did permit tax relief and ex-emptions (FR, IE, EL, IT, NL, ES). In Ireland, tax relief was also available when a private carer was employed.
Another minimal financial form of support, mentioned as available to Maltese and UK family carers, was VAT relief on care aids.
In Ireland carers are eligible both for respite care benefits and for a Back-to-Education allowance when their caring responsibilities end.
2.5.4 Long-term financial Support
The long term consequences for family carers have been noted in many coun-tries. Some countries have moved towards supporting those providing recog-nised levels of care in order to both support family carers and ensure that in the longer term they do not land up worse off. In some countries, family carers could be officially recognised and employed as carers with a salary, employ-
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ment benefits, pension and training (DK, FI, FR, IE limited, NO, UK). While these were the most extensive rights, other countries offered social insurance contributions to provide coverage for old age and accidents; pension credits are a recognised way of supporting family carers in a number countries (CZ, LU, NO, UK) while specific mention is made of coverage for accident and in-jury (AT, FI).
In Austria preferential insurance terms and pension contributions are given to non-employed family carers in the form of free non-contributory co-insurance with sickness benefits for those receiv-ing the long term care allowance for the more dependent (levels 4-7) with the state paying the employer’s contributions.
2.5.5 Formal Service Provision for older People (health, social services, residential)
Adequate and appropriate health and social services provided to older people, both in institutions and at home, are a major factor in supporting the work of family carers and relieving them of the total burden of care. In those countries with a broad spectrum of home care services (SE, DE, UK, NO, DK, FI, FR) that maintain and support older people in their own homes as long as possible, family members may have some choice in deciding whether and how much care they wish to undertake, although home help is often limited and does not exclude the need for help from the family. However the demographic projec-tions suggest that the degree of choice that older people and their family car-ers will have in the future may be dictated by public expenditure restrictions and private means.
In addition to services provided in the home (home-help, meals-on-wheels, personal care etc.), the provision of appropriate accommodation (permanent and temporary residential care, sheltered housing, home adaptations etc.) and transport services can significantly influence and extend an older person’s in-dependence and autonomy, despite increasing levels of disability, and this in turn helps family carers.
The Polish report describes how in some local areas, such as Poznan, initiatives have been undertaken to improve the quality of care and work conditions of family carers, largely as a result of pressure from well-organised self-help groups and NGOs of older people forcing local authorities to assign appropriate funds.
In Northern Italy, there is a current trend towards an increased involvement of market oriented care services, so that users (i.e. older people and their fami-
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lies) “buy” care services from private suppliers that are paid for with public funds through vouchers and care allowances.
At the other end of the spectrum, Greece has no statutory social care services for older people though some home care programmes have developed over the past decades, initially by NGOs and more recently by local authorities; budget restrictions and inadequate funding means that coverage is limited and the services inevitably give priority to dependent older people without family support and with no financial resources to pay for private help.
2.5.6 Services for older People at Home
It is not always easy to distinguish between services primarily intended for the older person but which substantially reduce the problems and difficulties of the work of the family carers, and those services which are directly focused on and of benefit to the family carer. Thus respite care may directly benefit and even be designed for the family carer, yet essentially be a home based service for the older person. A huge range of services supporting older people exists, in-cluding general laundry services, special transport services, hairdresser at home, meals at home, chiropodist / podologist, telerescue / tele-alarm (con-nection with the central first-aid station or relative), telephone service offered by associations for older people (friend-phone, etc.), counselling and advice services for older people, care aids, home modifications, company for older people, social worker, handyman service, incontinence service. (See Annex 4 for the list of services developed from the national reports.)
Malta mentioned having 30 different services for older people, though with the interesting comment that many family carers using home help services felt it to be an admission of their inability to live up to family expectations, leading to an uneasy partnership between them and the formal service providers
For family carers the availability of good primary health care in the home is of great importance, as many older people are not well enough to move easily. Many countries (BE, DK, FR, DE, LU, MT, NL, NO, SE, CH and the UK) de-scribed their primary health care services as comprehensive, involving health care professionals in systematic outreach programmes, and included services such as palliative care at home (CH), and rehabilitation at home. The UK in-terestingly stated that the most popular primary health care services for older people were chiropody and the district nurse. In other countries (AT, BU, CZ, IT), primary health service into the home were considered partial with inade-quate regional coverage, while other countries described their primary health care services as inadequate (EL, ES, HU, PL, PT, SL).
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The French primary health care system gives a legal right to its citizens to such services as hospital-at-home, a paramedical ser-vice and the delivery of drugs.
A strong trend noted in most countries was the growth in day care centres, whether attached to hospitals, run by local authorities or by NGOs. These cen-tres are of importance where the family carer works, but also for regular res-pite care particularly in the cases of older people with dementia. In some coun-tries (NO), coverage was relatively well-developed, apart from some of the ru-ral areas, while in other countries it was noted that coverage was very patchy (FR, IT, DE) with expansion being planned (IE, HU, EL) Only in Poland day care centres were actually decreasing in number. However, one should note the existing variations in the percentages using such centres. Belgium re-ported 0.3 % of those aged 65-70 years rising to 0.7 % for those 75 years and over. The Czech Republic, which had centres that offered day and weekend care, provided coverage for 0.6 % of those aged 65+. Malta had 5 % of it older citizens attending 14 centres, while in Spain coverage was for just 0.11 % of older people. Usage data was presented quite differently in the Netherlands – who reported 13 % of family carers using such centres, while in the UK 32 % of those receiving care went to such centres (day clubs, day care and day hospitals), a figure that went down to 27 % for those aged 85 and over. In Luxembourg, the 7 centres were designed for psycho-geriatric cases.
Home care services have been well established for many years in many countries and a wide range of services may be provided under this rubric in-cluding home help services (shopping, cleaning, cooking etc.) and personal care (bathing, cutting toe nails, toileting etc.) – however it was not always clear from the national reports what exact services were included in each category. The data provided shows the usage by the age of the older person - ranging from 1 % of those aged 65 years and over in Italy, to 15 % of those aged 60 and over in Denmark. Other figures demonstrate, not surprisingly, that the per-centages rise with increasing age. Denmark, Belgium and Finland commented that the average length of time for home help was just 2 hours per week, and many countries said that the demand was outstripping the supply both as a result of demographic changes but also, for example, with the introduction of long term care allowances which allowed dependent older people to have more access to such a service (AT). This indicates that many countries are facing the choices of how best to ration care to those who are most depend-ent. In the UK and Ireland, data indicated that those with family carers re-ceived less home care than those without a family carer.
In a number of countries including Finland, Sweden and the UK, it was com-mented on that home help was now given to less people but more intensively, e.g. in the UK 8.1 hours per week, while in Sweden 28 % received home help in the evenings and at night.
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Belgium noted that the main beneficiaries were those who were very depend-ent and on a low income and no doubt similar criteria are used in other coun-tries, which may well account for the growth reported in a number of countries of private home help services; thus even in Denmark with its extensive ser-vices, people were paying for additional help. In some countries the costs of using the service meant that some could not afford it (BU).
Local coordination centres were important as a way of ensuring some coop-eration between health and social services. In Finland, personal care and ser-vice plans are made by multi-professional health and social service teams for persons in continuous need for care and there is an increased focus on the much older person. In Greece, many of the home care services under devel-opment are run in conjunction with the existing Open Care Centres for Older People (KAPIs) and provide both some health and social support. In Sweden, comprehensive local authority services provide transportation services, foot care, meals on wheels, security alarms, housing adaptations, handicap aids, etc.
Home help care programmes in Catalonia, Spain, are available in 90 % of the primary health care centres; more than 75 % of these offer carer training and almost 69 % specific “caring for the carer” programmes.
Given the particularly arduous nature of care for those with Alzheimer’s dis-ease or DAT related dependency, the development of special services to sup-port family carers is particularly critical. Norway reported that 80 % of all the local authorities provided sheltered units in nursing homes for persons with dementia in 2003, while Belgium, Luxemburg, Sweden and Finland also had good coverage. However, most countries reported that existing facilities are inadequate in terms of coverage and increasing demand (FR, IT, DE, IE).
One bright light for family care work was that many countries re-ported on the invaluable work done by different NGOs and espe-cially Alzheimer societies, e.g. in the UK they had 25,000 mem-bers and 300 centres running quality day and home care ser-vices, while in countries like Slovenia and Greece mention was made of the growing importance of the Alzheimer societies, par-ticularly when other forms of support for older people and family carers were less developed. Only Spain, Poland and Portugal gave no indication of such developments.
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Even in Greece, where innovations are hard to implement and public financial support limited and erratic, the GARDA Associa-tion in Thessaloniki, supported by Alzheimer Europe, marks dy-namic and positive cooperation between health professionals and family carers with effective work in information, advocacy, counselling and service provision in an ever larger number of towns.
Quality Assurance
One way of ensuring that family carers feel that home care services can be safely used and relied on is that adequate quality assurance standards are in place. In many countries, the evaluation and monitoring of the standards of the service provided, whether by health or social care personnel in separate or integrated services, was felt to be inadequate. Many countries also reported that administrative criteria were the main criteria used to judge service ade-quacy, e.g. legal contract obligations, financial management, staff / client ra-tios, complaints, while even where local authorities had developed explicit cri-teria for service providers, these very rarely included the quality of the service from the perspective of the family carer or older person (AT, CZ, IE, DE, EL, PL, ES). What were the constituents of a good quality service assurance? These included national recommendations, the use of independent evaluation and monitoring, clear mission statements, the development of individual client plans drawn up with the older person or family carer, the development of qual-ity awards, and many countries felt they had adequate mechanisms in place (BE, DK, FI, FR, HU, LU, MT, NL, NO, CH, UK, SE). France noted that there were now special computer programmes designed for quality control for both home and residential care services.
In well developed systems it might well be expected that services would de-vote resources to ensure the level of training and competence of their staff. If European countries are moving to an increase in the number and coverage of both public and private care services in the home, then family carers and older people have to feel confidence in the abilities, commitment and concern of those providing services to the older person. 12 countries considered their staff adequately trained (AT, BE, BU, DK, LU, MT, IT, FI, DE, SE, NL, HU). However, there were differences between the qualifications of those run-ning services, who in most countries were trained and with professional certi-fication, e.g. as medical professionals, social workers etc, and those who pro-vide some kinds of hands-on care and support in the home. Austria, Italy and the Czech Republic commented on this issue. The difficulties in recruiting and keeping staff, especially at these levels, have already been discussed in the section on the work of caring (2.4.5). What was often missing was training for home help and geriatric aides. In Spain, the national report sadly pointed to the current inadequacies even amongst those of a professional background, since they often had inadequate profiles for the work, especially in supervision
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and management; there was also scarce interest by other workers in jobs con-cerning the hygiene and personal care of the older person and in general a poor connection between the workers and the users of the services. This comment may well have resonance for a number of countries, e.g. FR, SI, CH.
2.5.7 Services for Family Carers
The most common form of service available for family carers was some form of respite care, predominantly in residential units with rather fewer offering such care in the older person’s or family carer’s own home. Respite care ser-vices at home probably constitute the most direct and immediate type of relief for family carers, whether this be in the form of ‘granny’ sitting for a few hours, or for a more extensive period such as a weekend, or to cover a holiday and allow the family carer to relax. Respite care was the only service for family carers reported by all the NABARES countries, although there was a very wide variety both in type of provision and coverage. Such services are well de-veloped in a number of countries (BE, NL, NO, SE, UK, DK, FR), whereas in others any form of provision is rare in EL, IT, PL, ES, PT, SI and with more ex-tensive, but still limited coverage in IE, DE, CH, MT. As with many other forms of support for family carers, private arrangements for relief care either at home or in a residential facility, were reported by many countries, either as a substi-tute for inadequate public services, or in parallel with them.
In Belgium 10,000 hours of sitting services were provided, a half by volunteers.
In the Netherlands more than 180,000 hours of voluntary pallia-tive home care were provided at home (more than 5200 volun-teers in palliative care). In contrast to formal carers these volun-teers do have a lot of time for the family carers.
Given the bureaucratic nature of many of the public systems by which family carers can access services or claim financial support either for themselves or for the older person directly, a major problem for many is how to fill in the right forms. Thus counselling and advice services that helped with such things as filling out forms were surprisingly prevalent amongst many of the 23 countries and 8 reported this as available throughout their country.
In Austria a provider of in-home hospice services (Caritas) offers a support programme for carers after the death of the older per-son.
Practical training in caring was available widely, where family carers learned to protect their own physical and mental health, relaxation etc. (IE, SE, MT,
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NL, FI, FR, AT, BE, and the UK). A number of these were run by carer’s groups or NGOs. Many of these services overlapped with self help groups, de-signed to allow family carers to learn from one another how to deal with prob-lems and the emotional and practical aspects of caring.
Needs assessment by a service provider, providing a formal and standard-ised assessment of the caring situation, was a well developed service with to-tal coverage in DE, DK, FI, HU, BE, NL, SE, CH, UK, LU, partial availability in BU, CZ, DE, ES, IE, MT, NO, PL. but not available in AT, CH, EL, FR, IT, PT, SI, although the extent to which family carers were involved in these assess-ments was not always clear.
However, integrated planning of care for older people and their families, which should be a logical next step from needs assessment, was available in fewer countries, with total availability reported only in SE, UK, FI, HU and LU.
Whilst a number of countries reported special services for family carers of different ethnic groups, this was a statutory service only in the UK and even here was still not fully developed.
Other support services for family carers were reported by NL, HU and LU.
In Hungary, the vital role of NGOs such as the Hungarian-Maltese Charity service and the Hungarian Red Cross in providing nu-merous services for older people and their families was noted. Free food, clothing, medicine, medical and technical aids were provided where needed, using both state and other sources of funding and a large amount of volunteer work.
In the Netherlands, the important contribution made by the 200 Support Centres for Family Carers (information and advice, prac-tical and emotional support, training, mutual support groups, and voluntary home care and buddy care) was noted, as well as the wide variety of support services provided by LOT, the Dutch or-ganization for informal caregivers.
2.6 Residential and Long-Term Care
In this section, long-term care usually refers to institutional care provided and funded by the health sector, whilst residential care is usually provided by the social services sector with partial or full costs born by the user. However, it was not always clear from the NABARES reports which were being referred to and thus there may be some overlap between the uses of the two terms. From the point of view of the family carer and the older person needing care, how-ever, whether this type of care is provided free or for payment is obviously a major factor in decisions regarding the use of the service and may partly ex-
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plain differences in patterns of use of institutional care facilities between coun-tries.
While it would appear slightly contrary to discuss residential care and family care simultaneously, the availability and quality of different forms of residential care for dependent older people helps determine the role of family carers and the types of support they can find. There are different developments in the 23 countries that depend in great part on historic levels of provision; those with low levels are often seeing a growth in new residential units to deal with demographic changes, while those who already have high levels are diversify-ing the forms of residential coverage available. Increasing longevity accompa-nied by age-related disability (even taking into account some decline in rates of severe disability) means that a higher number of older people will require care for longer periods of time; this, combined with the predicted decline in numbers and availability of younger generation family carers, means that inevi-tably an increasing proportion of older people will require the intensive care services only available in an institutional setting. This is already becoming ap-parent with many countries reporting a high proportion of more disabled older people and those without families in residential care.
An increasingly wide range of institutional care arrangements are reported, with a general trend in those countries with more developed services to move away from traditional residential care and rest homes, nursing homes and short and long term hospital care and convalescent homes, towards other forms of living units such as sheltered housing, specialised rehabilitation facili-ties, hospice and palliative care facilities and special dementia units and spe-cial facilities such as respite care (AT, BE / Flemish, NL). This has led to a less rigid classification of types of institutional care, with merging of the boundaries between health and social care and between home and residential care, i.e. towards more integrated care.
There is a wide mix of public, private and non-profit provision, with most public and NGO facilities, except hospital beds, being run by or in co-operation with local authorities. The highest level of residential care was reported in the Neth-erlands with 5 % of those aged 65 years and over in residential care homes and 2.5 % in nursing homes, and Luxembourg with 6.8 % of those aged 65 years and over. The lowest rate was reported in Greece with an estimated 1.5 %. Overall, as many countries indicated there is an increase in both the age and level of dependency of older people, as well as the proportion of de-mentia sufferers, in all types of residential care and there are often waiting lists, especially for specialist and modern units, e.g. Belgium has long waiting lists for dementia patients. However, in interesting contrast, Finland reports a decline in need for institutional care due to improved functional capacity of those 65 and over. In Italy, a decline by half in the percentage of over 85 year
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olds in residential care has been attributed primarily to the employment of for-eign home care workers.15
There are significant cultural differences in the preferences of older people themselves for this type of care, though the time at which they were asked about their preferences as well as the wider socio-economic conditions in which they find themselves, also influences their responses. The critical issue is what they prefer when they can no longer care for themselves: nine out of ten Norwegian older people preferred a residential setting, while the Swiss also preferred professional care. Similar tendencies can be found in the Czech Republic, Poland, Slovenia and Hungary, where older people in need for care are put on waiting lists for admission and expanding long-term care and resi-dential facilities.16
While many countries reported a policy trend away from institutional care to-wards home care, some countries with high levels of mainly publicly funded residential care provision (AT, DK, SE) have not changed bed provision but have expanded other forms of residential care, e.g. sheltered housing in Nor-way, with a consequent decline in bed shortages in nursing homes. In Den-mark, the decline in nursing home beds has been matched by an increase in independent specialised housing units for older people with accompanying home care services, whereas Sweden covers all types of residential care un-der the umbrella heading “special housing”, entry being by criteria of need only, with a very high public service coverage and a wide variety of accommo-dation, balanced by improved and integrated home services provision. Finland has service housing with 24 hr assistance costing two thirds less than tradi-tional residential care and three quarters less than hospital care. In Spain, where residential care covers 3.4 % of over 65 year olds, the national report suggests an increase in public sector residential care. Malta and Germany noted increases in the demand for all types of residential accommodation, and in Germany residents consist increasingly of the older age groups and demen-tia sufferers. Even in Greece, despite the use of migrant workers and the start of some home care services, there has been a small increase in use of resi-dential care services (mostly private) from < 1 % to 1-2 % of > 65 year olds. A similar situation occurs, to a varying extent, in Italy, although there is a higher proportion of older people in residential care in the north than the south. Lux-embourg, with a currently high level of residential care provision, is expanding provision further and the report notes that the cost for such care per hour (35.82 euro) is actually cheaper than home care (48 euro).
In France, as in other countries, there are significant problems with many ex-isting residential homes, some of which are based on the old ‘poor-houses’,
15
See http://www.esf.org/articles/201/Famsuparticle.pdf 16
It is not entirely clear if this is because of established traditions or because of the difficult economic
circumstances of both families and older people.
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though the development of new forms of small support residential and modern units is making some forms of residential care far more attractive.
In France and the Walloon part of Belgium the Cantous are spe-cial small units for older people with dementia where they share daily life and cooking activities under supervision. The family is involved in decision making and social life.
The costs of residential care clearly play an important role for family carers and older people since in many countries the older person or their family con-tributes or completely pays for this service. In the Czech Republic, long-term care was free and a dependent person received their entire pension plus any dependency allowance. In Denmark, rent was payable for the accommodation only, while care services were free. Long term care allowances awarded in line with assessed levels of disability and need were mainly used in Austria and Germany to cover the costs of residential care. A large number of countries had some forms of mixed payment – Switzerland, Hungary, Malta, Poland, Norway, Finland, and the Netherlands used various forms of means tested and co-payment according to the older person’s pension, though ensuring that the older person was left with some disposable income. In France, Ireland and the UK, older people in residential care were often publicly funded, though assets had to be used to pay part or all of the costs. Thus the amount of public sub-sidy for residential care varied considerably amongst countries. In most cases the poorest and most dependent may get subsidised, as in Spain, though 58.8 % are financed entirely by the user. In Slovenia, 66 % is funded by older people and family carers. In both Greece and Portugal the percentage paid for by the older person is even higher and NGO and religious charities mainly ac-commodate the isolated and those on a very low income. In Italy, only 5 % of residential accommodation is free.
In Luxembourg residents pay the full cost of care, while in Sweden they pay the costs of rent, meals and care with a cap on the costs for care; in both cases high incomes and pensions and state subsidies for those in need mean that the costs are not a barrier to usage.
The funding of long term care in some countries may actually favour institu-tional care, e.g. in Italy and the UK, long-term health care facilities may be free or partially covered as opposed to payment for social care facilities, which is means tested or completely privately paid by older people or family carers; in Belgium / Flanders family care at home may be more expensive than residen-tial care; for family carers in the Czech Republic, residential care may allow them to benefit from the older person’s pension, even if this involves moving the older person every 3 months to different facilities to avoid paying costs.
Overall many countries noted the decreasing length of public hospital stay for older people with increasingly earlier discharge after acute admissions, e.g.
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Hungary. This puts increasing strain on both family carers and on home care services which have to provide higher levels of home care, e.g. UK.
While national and local governments may wish to limit public expenditure and older people and family carers prefer home or sheltered housing with home help services, as indicated care for dependent older people may cost a lot if they are kept in their original homes. There is no consensus of the optimum method of funding residential services and in many countries the choices available in different types of care facilities are very limited.
2.6.1 Sheltered Housing Units
Sheltered housing units are currently not available in a number of countries (BU, EL, HU, PL). Portugal noted the conversion of many of the older residen-tial homes into sheltered units, while Slovenia noted that though they have started there, there was reluctance amongst older people to sell the property and move into these relatively expensive dwellings. Both sheltered and other forms of residential accommodation offering support services are growing in most countries though they tend to be limited to those who are mentally dis-abled in Luxemburg, while in Norway older people with dementia may be ac-commodated in sheltered units in nursing homes. In the UK, figures showed 3.5 % of those aged 65+ in such housing, a figure that rises to 19 % for those aged 85 years and over. Again this availability of choice for the older person and family carer is important since the older person retains a home and inde-pendence though with appropriate 24 hour available support.
2.6.2 Hospices and palliative Care
Hospices and palliative care may be important for family carers, offering a specialist service to those needing terminal care and allowing both the older person and the family carers to get good psychological and physical care. They are not available in a number of countries including BU, EL and ES. In many countries such forms of service developed under the auspices of NGOs; thus the Czech Republic has 6 new units with 170 beds. In total, 11 countries mentioned the existence of hospices and palliative care, within residential units and in the community. Focussing on hospices and palliative care, the impor-tance of enabling family carers to continue care also in the terminal phase and to avoid institutionalisation must not be disregarded. Specifically, aspects like dignity and cost need to be reflected.
2.6.3 Residential Respite Care
As suggested in the earlier section (2.5.7), many countries de facto offer res-pite care, whether in specially designed units or as ad hoc arrangements.
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In Bulgaria the widespread summer camps are sometimes used for the care of the dependent older person while the family carers take a holiday break.
2.6.4 Training and Quality Control and Family Carer Involvement
As discussed under home care services, the issue of training of care staff and quality control of residential care services is critical, particularly in those coun-tries with low usage. As with home care services, some countries employed a majority of skilled trained staff with the tendency for the less skilled categories of professional carer to be the ones with the least training or continuous edu-cation. The Czech report indicates the importance of this issue since the de-pendency levels in their institutions is worsening.
Again there is a tendency in many countries for administrative criteria to be used to asses quality standards, e.g. they focus on health and safety, staff- resident ratios, space and facilities. However ISO standards have begun to be introduced and were mainly regulated by local authorities (UK has twice yearly inspections, one unannounced and reports are published – the Care Stan-dards Act now sets national standards). FI implements repeat questionnaires for client feedback on quality i.e. availability, adequacy and functionality of ser-vices.
The involvement of family carers in residential care services appears to be in-creasing in Malta and the Netherlands and in Norway cooperation between staff and family caregivers is encouraged. This is partly due to changes from traditional forms of residential care to a wider variety of services, many of which involve family carers (respite care, shared care, etc.) and partly due to changing attitudes to and perceptions of care for older people. In Poland, Italy and Greece, family carers are often encouraged or even obliged to supple-ment and supervise residential care services that are inadequate due to lack of or indifferent, non-trained staff. Increasing budget cuts for residential care means that family carers and volunteers are increasingly needed to provide all forms of care (NL).
Additionally, family carers are increasingly concerned with the quality of care and feel themselves “partners in care” with formal service providers.
2.7 Current Policy Trends and Debates
Given the very different economic and welfare situations in each of the 23 countries, the discussions and the sophistication of social policy debates being held at local or national level vary enormously. This was particularly the case with respect to family care. Each national expert was asked to report on the state of debate on family care in their country and, though their comments may not be comprehensive they indicate what trends are occurring in each country.
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As should be clear, in a number of countries a discussion or policy debate on the issue of family care does still not take place. While in most of these coun-tries (PL, EL, SI, MT, BU) this is the outcome of there being an assumption of the ‘normalcy’ of family care and / or laissez faire public welfare policy towards citizens, in the case of Denmark the lack of discussion is for the opposite rea-son, namely the policy of total state care for all dependent older persons. Other countries reported some growing consciousness of the likely increase in demand for support from the public sector as a result of the increasing num-bers of older people and the difficulties faced by family carers (BE, CZ, IT, FR, HU, CH). Unless family carers and older people are within a very well devel-oped welfare state, it appears that those with increased incomes turn to private solutions. Many public authorities essentially limit themselves to reactions to crisis rather than being proactive in the support of family carers. However, whether the state has primary responsibility for the care of older people or whether families or the individuals themselves bear the weight of care, there is some convergence in awareness of the need for shared care (public and fam-ily), whatever the starting point.
Not surprising given the demographic developments, public debate in many countries is concerned with how the public sector would be able to cover the costs of long term care of older people (FR, IE, BE, EL, NL, NO, SE, AT, LU, DK). The central debate revolves around who should pay - whether this should be funded through new taxation and new forms of social insurance and whether these should be public or private and born primarily by the older per-son and / or his / her family. The Austrian, German and Dutch evaluation un-derway of the effects and costs of the long term care insurance scheme will help countries like Spain and France who are considering setting up LTCI.
Providing adequate financial incentives to increase the numbers of individuals willing to provide family care is a debate in Switzerland (whether payments are made directly to the family carer or indirectly through the older person) and the current very low levels of reimbursement in a number of countries such as Austria is clearly no incentive. However, as referred to in the next section, any system of payment for family care will require adequate, continuous and objec-tive needs assessment of the older person if family carers are to be paid from the public purse.
As suggested in an earlier section, enforcing the provision of hands on care by the children of older people appears to be, in practice, unworkable; even mak-ing children take financial responsibility for dependent parents is difficult to im-plement, as illustrated by the current policy debate in Ireland, despite the fact that the country still has larger families to draw on for the financial support of their older members, as well as growing wealth. Italy was involved in a policy debate about whether payments to family carers were preferable to payments to the older person; both these systems were found amongst the 23 countries and it was evident that each had some drawbacks.
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Much larger social issues are the central point of policy debates in many coun-tries. Thus the Lisbon agreement to increase labour force participation rates, especially those of women, throughout the member states of the EU has clear repercussions for the practical day to day support of older dependent people and indeed all types of home care. Will women in the future be willing to un-dertake both paid and unpaid care to the same degree, particularly in those countries that currently mainly rely on family care? In countries where family care issues are high on the agenda, defending carers’ rights to equality is a major policy debate; this has been particularly successful in Ireland where dis-crimination legislation also covers family carers as workers.
In Portugal the rapid social changes that are occurring are leading to a debate on individualism, life style changes and what they mean in terms of family care. The wealth of Norway has allowed them to provide both good services for older people without devaluing the place of family carers, by clarifying the roles of service providers and family carers in the provision of home care for the very dependent. As the Austrian report makes clear, those with better edu-cation and with better jobs are less willing to provide hands-on-care, a trend that will most likely be repeated throughout Europe. However, the OASIS study suggests that, given adequate services, family carers may be better able to provide more emotional, recreational and psychological support, thus, main-taining and improving the personal relationship between family carer and older person.
Malta and the Czech Republic were involved in policy debates concerning how they could change social attitudes towards ageing and promote greater inde-pendence amongst older people, which would also aid family carers. Nonethe-less, however much there is a chronological postponement of ageing, ulti-mately the fear of death and dependency at the end of life give a negative aura and set of attitudes. As the UK mentioned there is still the problem of the frail, ill and dependent older people and how to make positive social values out of this stage of the life course. The specialist role of residential facilities and hos-pices who may best be able to promote a positive image and experience about the end of life, “a good death” for older people and their family carers, was not mentioned directly in the reports, though the growth of hospices and their wide public support suggests that they may have started to play such a role.
The issue of family care has different advocates in some of the 23 countries. The strength of the family care associations and related NGOs in Ireland and the UK as well as in Finland and in the Netherlands is reflected in the fact that they are major stakeholders in the debates about the support of family carers, while in Italy it is the pensioners organizations who have taken on this policy issue with the regional and central governments.
A number of countries pointed to the fact that the main policy debates con-cerned the provision of more services even though, as in Luxembourg they were already relatively well off. There the main focus of the debate was on the
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need for more rehabilitation services, palliative and hospice care and more trained workers. In others (CZ, ES, HU), the pressing need for more home care services for older people was the main focus, including more respite care services at home (NL). With regard to the latter, countries with the same policy concern could benefit from an evaluation of systems implementing respite care at home using voluntary or semi-paid substitute carers. Finland, with already good services in place, was involved in policy debates about introducing more flexibility in care to cover different levels of disability. A number of countries reported policy debates on how best to improve the status of family care work and ensure cooperation between family carers and the professionals in the provision of health and social services. This included the debate on whether and how to make family carers municipal workers (BE, FI, NL, AT, IE) as part of the team of care workers, thus blurring the traditional divisions between formal and informal care provision and the private and public spheres of life. Inevitably this had repercussions in the conclusion that more training would be needed for family carers (NL, DE).
Assuring good quality control for services for older people and family carers was a major issue in several countries (IT, EL, NO, DK). The development and implementation of ISO standards for both residential and particularly home care services where supervision is more difficult, would appear to be an impor-tant area for cross country co-operation within the EU, through both research and the open method of co-ordination.
The issue of need for legal guardianship for frail older people was reported by Italy and Luxembourg and, taking the issue further, Finland and the UK noted the need for judicial and advocacy support for both family carers and cared for older people. In response to this problem, Poland has developed good legal protection for older people against financial abuse, but it should also be noted that both family carers and older people would benefit from clear legislation in the form of contracts ensuring fair exchanges and payments in return for care, with due protection for the older person’s rights.
The detection, prevention and management of elder abuse was a policy de-bate in Austria and Belgium, and there are strong indications in the NABARES reports that this is of concern widely within Europe. It is also a major concern amongst policy makers in the USA.
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3 Conclusions and Policy Implications
Despite the fact that many countries in Europe still do not acknowledge the role of family carers in the social and health support of older people, it should be evident from this report that politicians and policy makers at local, national and EU levels ignore the changing demographic structure of Europe at their peril!
The frequently mentioned ‘burden’ and spiralling costs for the care of depend-ent older people can only be confronted by utilising all available resources in a partnership approach to care. The four sectors of the welfare diamond (public, voluntary, family and private) concerned with the provision of care for older dependent people need to find a new balance in ways of working together, based on clearly agreed areas of responsibility. The policy in the EU to en-courage the labour market participation of women, including older women, will further reduce the already diminishing pool of family carers able to devote adequate time to hands on care and many ad hoc forms of care currently util-ised to fill this gap may not be the best solutions. The public sector, already responsible in large part for the health care of its population, needs to take a proactive role in the allocation of responsibility and the development of support for family carers.
Policy implications and recommendations are derived from the NABARES re-ports and what the national experts initially considered to be critical in their country for the support of family carers. However, the countries mentioned in the footnotes for each issue are in no way exhaustive and many authors sub-sequently commented that only their need to be selective had limited the inclu-sion of many of the other topics listed below. These and other issues emerge as areas where action might effectively be taken at the EU or at national and local levels for the support of family carers. This section covers issues con-cerned with types of support for family carers, service organization and provi-sion and, critically, the way in which family care can be an integral and ac-knowledged element in the care for dependent older people within the wider context of labour market policies.
The authors hope that the ideas discussed in this report, and the policy impli-cations summarised below, will stimulate thinking on how best each country can innovate and find solutions for the support of family carers.
3.1 More Services for Family Carers and older People
� Encourage innovation in providing new services for family carers and older people17
17
BE, UK, EL, AT
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� More short term and flexible respite care18
� More medium and longer term respite care centres19
� More day care20
Respite care is a key service in those countries where family carers undertake a lot of practical care. Consideration should be given to ways of covering long and irregular working hours for working carers including 24 hour and week-end care.
The trend in more advanced countries to have a variety of forms of flexible and attractive residential care to suit the various needs of both dependent older people and their family carers is one that needs to be systematically devel-oped in more countries.
� More palliative care21
� Palliative care22
The emergence of palliative care as a specialty both as a home and residential service, can alleviate the problems and concerns of both older people and their family carers and contribute to optimum care at the end of life. The role of humanitarian and religious organisations in this area of care should be ex-panded.
The promotion of local or regional Centres of Excellence which include training for family carers and professionals in palliative and end of life care.
Collaborative work with humanitarian and religious organizations at EU level.
� More formal, publicly supported home care services, e.g. home nursing, home help23
� More provision of specialised services at home, e.g. dental care, diagnostic services, rehabilitation, chiropody24
� Structures (financial, administrative) to support those with long term health care needs (ambulatory, residential and psychiatric)25
The wide disparities in the provision and coverage of home care services for older people in the 23 countries of the NABARES reports, underlines the ine-qualities currently experienced by family carers.
18
AT, DE, IT, IE, EL, NL, SI 19
AT, DE, EL 20
FR, PL 21
AT, DE 22
HU, PT 23
HU, PT, NO, FI, CZ, EL, PL, SI 24
PT, EL, SI, NO, FI, CZ 25
PT, CZ, EL
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Within the EU the open method of co-ordination could stimulate member states to consider how to make the coverage of home care services more ex-tensive as well as methods of funding such services.
The extension of specialist services into the home requires the development of new technologies and lightweight equipment; the recognition of the market demand for such services may stimulate the private sector. The experiences of countries such as Finland with well developed public home health care ser-vices would be valuable.
Professional concern with the issue of long term health care at home is cur-rently at the centre of much discussion both at national and international levels (Groves and Wagner 2005, WHO 2005, WHO 2003)
The cost benefits of all forms of prevention and rehabilitation would be a good area for EU research and development.
� Meeting needs of those with dementia including more special residential care units and disseminating knowledge about dementia26
The important work of the Alzheimer Associations and groups throughout Europe was noted in most reports in the promotion of carers’ interests. This is an example of positive cooperation and an excellent multiplier effect when pro-fessionals and family carers work together.
� The effective development of services in rural areas27
Most countries in Europe have rural areas with high proportions of older peo-ple and difficulties in extending services into these areas at a reasonable cost. Hungary has managed under difficult economic circumstances to develop net-works of support using neighbours, friends and volunteers.
Cooperative research on the most effective and economic forms of support for OP in rural areas
� More home renovations and adjustments28
Using local resources and local staff to implement home modifications that aid family carers and dependent older people is a valuable and economically fea-sible service that could be provided by all local authorities.
3.2 Financial Support
� Financial support for family carers regardless of other financial support, e.g. widow’s pension29
26
AT, DE, BE, EL, IE, FR 27
NO 28
FI 29
FI, CZ, EL, SI
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The short and long term benefits and their implications for the public purse of providing different forms of financial support for carers was not clear from the NABARES reports.
The short and long term benefits of varying forms of financial support to family carers is an important issue where exchanges of experience at EU level may be contribute to evidence based policy making.
Ensuring that family carers are adequately covered by social insurance (acci-dents, health, pensions etc) during the time spent caring should be a minimum EU standard contributing to the reduction of long term poverty amongst those who undertake family care.
Linking obligatory training to payments for care, as in Finland, helps to ensure both quality in care provision and adequate incomes for family carers.
� Encourage business sponsorship and other donors to fund support services30
The issue of how to fund services is critical for the majority of countries and mixed solutions need to be experimented with.
The exchange of information amongst EU countries on innovative and mixed forms of funding of services should be encouraged.
� Tax allowances and benefits for family carers 31
These exist in many countries, though often in lieu of any other form of sup-port.
National governments can use tax declarations as a way of estimating the numbers of householders claiming to look after dependent older relatives.
� Develop Long Term Care Insurance32
The central issue is that of funding and the willingness of governments and citizens to bear the generally increased costs through indirect or direct taxa-tion. The Austrian, Dutch, German and also the Japanese experience will be valuable.
3.3 Working Carers
� Promoting flexible workplace practices for family carers33
Development of part-time work in line with needs of both the employer and employee.
30
BU 31
FI 32
FR 33
AT, DE, IT, FI, UK, SI
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The development of comprehensive labour market policies to include “caring as a lifetime resource” within the context of reconciling work and family life, e.g. part time work for both men and women with full pension and insurance credits for specified periods of time devoted to the care of children, dependent adults and older dependent people.
3.4 NGOs, Advocacy, Information, legal Advice, Counselling
� More information for family carers and older people34
This issue also emerged as important for family carers in the national surveys undertaken in the 6 core countries. All four sectors concerned with family care have an important, if different, role to play in the provision of information. Link-ing with successful disease-specific groups (Alzheimer, Parkinson’s, diabetes, etc.), as well as NGOs and advocacy groups to develop common interests and issues promotes effective collaboration and outcomes.
The proposed EUROCARERS NGO may consider making web and other links to existing NGOs and disease specific groups to promote general knowledge and common policy issues, e.g. service standards, effective support for family carers.
The vulnerability of many older dependent people and also family carers to exploitation and abuse needs to be addressed through adequate public legis-lation that several countries have already put in place.
Examination of legal issues relating to family care at EU level, e.g. guardian-ship, financial abuse.
� Not to shift financial costs of care to family carers 35
The promotion of the EU Carers’ Charter of Rights aims to protect family car-ers.
� Support formation of carers’ groups 36
The founding of a EUROCARERS group may help to give the issue a Euro-pean wide profile, but changing mind sets is not easy.
� Promotion of family care as work 37
One debate is whether policy development for family carers of older people should be included with that of family carers of dependent people of all ages. Unified policies have the advantage of avoiding age discrimination in support for family carers of older people, though the younger disabled may feel that
34
BE, BU, FI, EL, PL 35
FR 36
MT, EL, SI 37
NL
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public resources for their family carers may be ‘diluted’ by the increasing needs of older dependent people.
The current discussion at EU level for the adoption of compulsory social insur-ance for family carers providing assessed levels of care above, e.g. 18 hours per week, is a positive development.
� Targeted public relations to promote public recognition of family carers38 and support civil society (NGO) initiatives 39
National, local and EU support for family carers advocacy groups is a way of promoting partnership between the sectors involved in family care.
The continuing financial and political support of the EU for organizations such as those in the Social Platform (including AGE), as well as others of relevance, is critical for their survival.
3.5 Formal Labour Force
� Incentives to increase recruitment into nursing and care work with older people by raising the status and improving the conditions of employment 40
� Targeting men
The evidence from a number of countries suggests that poor recruitment and retention in care work can be successfully overcome, although this may be partly dependent on the national economic situation and the labour market. Improving the training and status of the work as well as conditions of employ-ment are key elements to success. The recruitment of men as care workers may aid in the improvement of the status and wages of care work.
Scholarships for those in residential and other caring work.
Well-funded chairs in gerontological nursing and geriatric medicine
The development of EU recognised training standards and programmes for care workers.
In conjunction with national training schemes advertising campaigns by na-tional governments to promote a better image of care work. Such a campaign may also choose to target men as care workers.
� Optimize the recruitment of migrant care workers at all levels and regulate the private care services 41
38
DE, IT 39
HU, PT, IE 40
BE, DE, BU 41
DE, IT, EL
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The significant role of migrant care workers suggests the need for more meas-ures not only to regulate and legalise their status but also to ensure their train-ing. The current unregulated use of migrants as private care workers in many countries is a temporary solution for the privileged middle classes as a re-sponse to a lack of public policy and services.
Encouragement of more EU training programmes to support migrant care ser-vice enterprises and migrant care workers training.
� Innovative practices and new technologies including the legal basis to help with assistive technologies and IT 42
The EU is already experimenting with IT and assistive technologies for older people and family carers.
Continued and increasing EU investment in research and dissemination of technologies that can aid care work and the organization of services.
3.6 Needs Assessment
� Systematic carer assessments43
� Care work involves a wide range of tasks in addition to support for household tasks and personal care, e.g. dealing with officials, financial support, gardening, accompanying.44
It is important to include all these areas in the needs assessment although this assumes the development of at least some appropriate support services for family carers or older people. A clear agreement on responsibilities between professionals and family carers for the various caring tasks is needed at the service level (see also section 2.5.7 on integrated care).
National and EU standardised comprehensive needs assessment procedures should be developed for older people, which include assessment of the role and needs of the family carer45. We need feedback on the effectiveness of ex-isting systems.
3.7 Promotion of Health and Well-being for Family Carers
� Gender-sensitive health promotion and prevention for family carers46
42
IE 43
UK 44
HU, DE 45
The COPE Index, CAMI, CASI and CADI are all validated carer assessment instruments.
http://www.shef.ac.uk/sisa/index.html 46
DE, IE, UK
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The promotion of well being amongst family carers also contributes to an im-proved well being of the older people they care for. Although the national gov-ernments and the EU have worked on health promotion with respect to older people, less has been done for family carers.
Public authorities and policy makers should work closely with the media (e.g. public television and radio stations) to develop programmes aimed at family carers at home (skills training, counselling advice, chat shows, information)
� Provide more counselling for family carers47
Feedback is needed on the effectiveness and cost benefit of counselling in preventing carer depression and break down and in the promotion of carer’s well being.
� Programmes to support autonomy of OP48
An important issue in many countries where older people traditionally expect to receive family care and may not appreciate their own role in maintaining their physical and mental independence and well being.
Local authorities could contribute through a variety of programmes promoting active social participation of older people and their family carers.
3.8 Evaluation and Monitoring
� Involve family carers and older people in monitoring services improving evaluation49
Develop EU project on methods of effective, efficient and easily implemented evaluation for service providers and family carers.
ISO standards for all types of care services at EU level need to be imple-mented and encouraged in all European countries as a way of promoting qual-ity evaluation. This is an important area for cross country cooperation in the development of standards
� Supporting the national registration of family carers50
The difficulties of defining family carers are general and though a national reg-ister would help there has to be a real incentive to register.
47
UK 48
PT 49
UK, DK, SE 50
MT
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3.9 Integrated Care and Training
3.9.1 Professionals
� Better co-ordination between different providers (usually health and social services), including any necessary legal provisions for cooperation between them51
Incentives for the provision of integrated care are being widely discussed by policy makers and professionals, e.g. the CARMEN Network http://www.ehma.org/projects/carmen.asp
� Better links between home and institutional care – integrated care (cooperation between multi-professional teams and family carers as team members).52
Integrated training needs to include decision makers and managers, as well as care workers and trainees.
� More training in the care of older people as well as training in team work for general medical practitioners53
Integrated care involves training in working as a member of a team that in-cludes family carers where relevant, and promotes links between sectors and improving geriatric knowledge.
Abolishing barriers to joint working between health and social services for older people is critical to the promotion of flexible and person centred care.
Higher education and continuous professional training institutes need to incor-porate training in integrated care for all professional team members (health and social service personnel and other support staff).
3.9.2 Family Carers
� More training for family carers and care support services54
� More training for family carers in multidisciplinary teams55
The “caring professions”, e.g. doctors and nurses, learn how to provide good professional care services without too much emotional involvement. Family carers, especially those providing a lot of hands on care, can be taught to “pro-fessionalize” some caring tasks allowing them to be more effective and effi-cient and to protect their own health. As well as organised training pro-
51
AT, BE, BU, HU, IE, PT, NO, PL, ES, FI, CZ, SI and DE (with respect to discharge.) 52
AT, BE, BU, DE, UK, CZ, EL, NL, ES, PL, SI 53
BE, BU, DE 54
AT, DE, BU, PT, FI, UK, CZ, EL, FR, SI 55
FI, PL
Conclusions and Policy Implications
65
grammes, outreach ‘on-the–job’ training for family carers in the home by pro-fessionals is a practical and necessary alternative.
Health authorities should set up mechanisms, e.g. case conferences, outreach programmes, for the active and informed inclusion of family carers in inte-grated teams.
Training programmes for family carers need to be more widely developed and routinely include home based training by professionals (learning by doing).
3.9.3 Volunteers
� More training for volunteers56
� Further development of training concepts for volunteers working with family carers and older people57
The importance of volunteer work with family carers of older people is highly variable between the 23 countries. They may be particularly important in sub-stituting for family carers in the lighter forms of home care services, e.g. shop-ping, cooking, errands, as well as granny sitting and short term respite. Given the noted tendency for home care services to concentrate more on the most dependent section of the elderly population this form of volunteer support may have increasing value for family carers in the future. Consideration needs to be given to methods of increasing and ‘professionalizing’ some volunteer work so that it becomes a reliable service as well as informal arrangements. The partial payment of trained volunteer groups may provide particular social value to their work and help in the development of more extensive volunteer services in some countries. The role of organised volunteer work in supporting family car-ers has been under-researched particularly regarding the relative importance of different forms of volunteer service.
Local authorities responsible for the development and provision of services for older people should consider partial funding for organised, trained volunteer groups.
EU research is needed on evaluating the experiences of countries with volun-tary or semi-paid volunteer services, and trained vs. non trained volunteers, e.g. in the provision of respite care at home.
56
DE 57
DE
EUROFAMCARE – Pan-European Background Report
66
4 References
All the national reports (NABARES) contain their own bibliographies: http://www.uke.uni-hamburg.de/extern/eurofamcare/presentations.html
National Background Reports listed by Country:
Josef Hörl (2004) National Background Report for Austria
Anja Declerq, Chantal Van Audenhove (2004) National Background Report for Belgium
Lilia Dimova, Martin Dimov (2004) National Background Report for Bulgaria
Iva Holmerová (2004) National Background Report for Czech Republic
George W. Leeson (2004) National Background Report for Denmark
Terttu Parkatti, Päivi Eskola (2004) National Background Report for Finland
Hannelore Jani (2004) National Background Report for France
Martha Meyer (2004) National Background Report for Germany
Liz Mestheneos, Judy Triantafillou, Sofia Kontouka (2004) National Back-ground Report for Greece
Zsuzsa Széman (2004) National Background Report for Hungary
Mary McMahon, Brigid Barron (2004) National Background Report for Ireland
Francesca Polverini, Andrea Principi, Cristian Balducci, Maria Gabriella Mel-chiorre, Sabrina Quattrini, Marie Victoria Gianelli, Giovanni Lamura (2004) Na-tional Background Report for Italy
Dieter Ferring, Germain Weber (2005) National Background Report for Lux-embourg
Joseph Troisi (2004) National Background Report for Malta
Reidun Ingebretsen, John Eriksen (2004) National Background Report for Norway
Piotr Bledowski, Wojciech Pedich (2004) National Background Report for Po-land
Liliana Sousa, Daniela Figueiredo (2004) National Background Report for Por-tugal
Simona Hvalic Touzery (2004) National Background Report for Slovenia
Arantza Larizgoita (2004) National Background Report for Spain
Lennarth Johansson (2004) National Background Report for Sweden
References
67
Astrid Stückelberger, Philippe Wanner (2005) National Background Report for Switzerland
Geraldine Visser-Jansen, Kees Knipscheer (2004) National Background Re-port for The Netherlands
Mike Nolan (2004) National Background Report for the United Kingdom
Other References
Albert J and Kohler U (2004) Health care in an Enlarged Europe. European Foundation for the Improvement of Living and working Conditions, Dublin.
Groves T, Wagner E (2005) Editorial: “High quality care for people with chronic diseases” BMJ 2005; 330:609-610
Giddens A (1991) Modernity and Self-Identity: Self and Society in the Late Modern Age, Cambridge, Polity Press
Johansson SL (2004) NABARE Sweden
Magnusson L (2005) “Designing a responsive service for family carers of frail, older people using information and communication technology.” Dissertation for Goteborgs universitet, Goteborg,
Pflüger K (2004) “Study into the impact of EU policies on Family Carers”. AGE older People’s Platform, Brussels.
Pijl M (1994) “When private care goes public: an analysis of concepts and principles concerning payments for care”. In Payments for Care: A Compara-tive Overview. European Centre Vienna, Avebury.
Robine J Romieu I (1998) “Health expectancies in the European Union: pro-gress achieved”. REVES Paper 319. INSERM, Montpelier, France.
Theobald H (2003) Social Exclusion and the Care of the Elderly. CARMA (Care for the Aged at Risk of Marginalisation), EU report. Berlin: WBZ Social Science Research Centre.
WHO (2005) Preparing a Health Care Workforce for the 21st Century: The Challenge of Chronic Conditions, WHO Geneva.
WHO (2003) Key Policy Issues in Long-Term Care http://whqlibdoc.who.int/publications/2003/9241562250.pdf
Related Studies and Programmes
CARMEN - the Care and Management of Services for Older People in Europe Network http://www.ehma.org/projects/carmen.asp
EUROFAMCARE – Pan-European Background Report
68
EUROCARERS: European Organisation on Informal Care
http://www.york.ac.uk/inst/spru/eurocarers.htm
European Foundation for the Improvement of Living and Working Conditions http://www.eurofound.eu.int/
European Observatory on the Social Situation, Demography and the Family http://europa.eu.int/comm/employment_social/eoss/index_en.html
FELICIE - Future Elderly Living Conditions in Europe http://www.felicie.org
IPROSEC - Improving Policy Responses and Outcomes to Socio-Economic Challenges: changing family structures, policy and practice http://www.iprosec.org.uk/xnat.html
OASIS - Old Age and Autonomy: The Role of Service Systems and Intergen-erational Family Solidarity http://oasis.haifa.ac.il/
PROCARE – Providing Integrated Health and Social Care for Older Persons: issues, problems and solutions http://www.euro.centre.org/procare/
SHARE - Survey of Health, Ageing and Retirement in Europe http://www.share-project.org/
SOCCARE – New Kinds of Families, New Kinds of Social Care
http://www.uta.fi/laitokset/sospol/soccare/
Annexes
69
5 Annexes
5.1 Annex 1
5.1.1 NABARES Country List and Abbreviations
1. Austria AT
2. Belgium BE
3. Bulgaria BU
4. Czech Republic CZ
5. Denmark DK
6. Finland FI
7. France FR
8. Germany DE
9. Greece EL
10. Hungary HU
11. Ireland IE
12. Italy IT
13. Luxembourg LU
14. Malta MT
15. The Netherlands NL
16. Norway NO
17. Poland PL
18. Portugal PT
19. Slovenia SI
20. Spain ES
21. Sweden SE
22 Switzerland CH
23. United Kingdom UK
EUROFAMCARE – Pan-European Background Report
70
5.1.2 NABARES Analytic Matrices and Abbreviations in Matrices
< under
> over
Aut.Com. Autonomous Communities in Spain
Cos Companies
FC family carer
Fed. Federal
HH home help
Hrs hours
HS Health Services
LA Local Authorities includes municipalities
LTC Long term care
LTCI Long term care insurance
Ltd limited
NGO non governmental organization
NI National Insurance
OP older person
OW older women
p.a. per annum
p.m. per month
p.w. per week
PHC Primary Health Care
Rehab rehabilitation
SS Social Services
Annexes
71
5.2 Annex 2 – Future Research Needs
Hardly surprising given that the national experts were researchers, when asked to make recommendations on what research was needed, they had a long list of suggestions. The lack of common definitions and standards for gaining data means that national reports are not always easily useable at EU level. Greece, Poland, Portugal and the Czech Republic stated they would be happy to see any national research undertaken on the subject of family care and support services since so little research had been done. Specific sugges-tions are listed below.
� Longitudinal studies / cohort investigations at a national level. (AU, FR, DK, IT) including the needs and expectations of future cohorts of older people (BE)
� Families as long standing exchange systems; motivation of spouses and descendants to care, not to care and to stop caring (FR, AT, HU)
� organisation and economy of service provision, in particular the balance between public and private provision; issues related to financing, the bal-ance between services, and future planning of services (BG, FIN, NO)
� Empirical studies of elder abuse (AT, FI, FR, DK,UK)
� Action research e.g. aimed at supporting practice, via stepped-care and shared-care methodologies. (AT, BE, UK)
� Paid private care at home, migrant carers and their role as illegal and legal domestic care workers (IT, DK, DE)
� Gender specific aspects of family care (DE, FI, FR, MT)
� Carers in employment, conflicts between care and work, and a comparison with non working carers (FR, SE, UK, MT)
� Young carers (SE, UK)
� Family care and coping in everyday life, positive aspects of caring, strate-gies to cope with the burden (IE, FR, UK)
� Normative attitudes in society towards caring responsibilities- changing values in relation to income and education and increased female labour market participation (IE, FR, MT)
� Factors determining differences in the awareness of public services and the impact on use (ES)
� Dependence insurance including the evaluation of dependency, degrees of coverage, types of insurance and financing, price and the criteria of deter-mining the right to coverage (ES)
� Caring for persons with rare diseases (SE)
EUROFAMCARE – Pan-European Background Report
72
� Caring and ethnic groups and emigrants (SE, FR, DK)
� Validating evaluation procedures to measure user satisfaction in collabora-tion between the formal care and service system and family care (SE)
� Innovate Case Management and the role of New Public Management in the organising of care of older people and the perspectives of older people and family caregivers.(DE, NO)
� Dementia and family care (DK)
� The use of technology to support family carers and older people and re-duce their isolation (UK, IE)
� Carers support in rural settings (SE, FR, NO)
� Outcome of carers support (SE, FR)
� Comparison of care given by co-resident versus non co-resident family carers. (MT)
� Examination of the responsibilities and needs of the ‘sandwich’ generation of carers (Carers with multiple care obligations (MT)
� Need for “objective” policy proposals based on cost / benefit to all parties
Annexes
73
5.3 Annex 3 – STEP for NABARES
The standardised Evaluation Protocol (STEP) for the Reports had the following sections
� Introduction – An Overview on Family Care – 2-3 pages
� Data for each country on:
1. Profile of family carers of older people
2. Care policies for family carers and the older person needing care.
3. Services for family carers
– Good practices
– Innovative practices in supporting carers.
4. Supporting family carers through health and social services for older people
4.1. Health and Social Care Services
4.1.1. Health services – primary, secondary and tertiary care
4.1.2. Social services – home care services and residential care
4.2. Quality of formal care services and its impact on family care- givers
4.3. Case management and integrated care (integration of health and social care services to organise care around the patient / client).
5. The Cost – Benefits of Caring – how much does care cost and who pays
6. Current trends and future perspectives in family caregiving in each coun-try
7. Appendix to the National Background Report
7.1 Socio-demographic data on older people – Profile of the older population – past trends and future perspectives
7.2 Examples of good or innovative practices in support services
8. References to the National Background Report
Finally, and most importantly, we asked the authors to write three overviews to be used for national and EU policy recommendations in the final phase of the project with Key Points aimed at:
� Representative organisations of family carers and older people
� Service providers
� Policy makers
EUROFAMCARE – Pan-European Background Report
74
5.4 Annex 4 – List of Social Services for Older People
The following services were identified in the reports:
� Permanent admission into residential care / old people’s home
� Temporary admission into residential care / old people’s home in order to relieve the family carer
� Protected accommodation / sheltered housing (house-hotel, apartments with common facilities, etc.)
� Laundry service
� Special transport services
� Hairdresser at home
� Meals at home
� Chiropodist / Podologist
� Telerescue / Tele-alarm (connection with the central first-aid station or rela-tive)
� Care aids
� Home modifications
� Company for the older person
� Social worker
� Day care (public or private) in community centre or residential home
� Night care (public or private) at home or in a residential home
� Private cohabitant assistant (“paid carer,” mainly migrant care workers, le-gal or illegal)
� Daily private home care for hygiene and personal care
� Social home care for help and cleaning services / ”Home help”
� Social home care for hygiene and personal care
� Telephone service offered by associations for older people (friend-phone, etc.)
� Counselling and advice services for older people
� Social recreational centre
� Other, specify
5.5
A
nn
ex 5
– M
atr
ix S
erv
ice
s f
or
Fam
ily C
are
rs f
or
23 C
ou
ntr
ies
Ava
ilab
ilit
y
Vo
lun
tary
Serv
ices f
or
fam
ily c
are
rs
No
t P
art
ially
To
tally
Sta
tuto
ry
Pu
blic, N
on
sta
tuto
ry
Pu
blic
fun
din
g
No
pu
blic
fun
din
g
Pri
vate
Needs a
ssessm
ent (f
orm
al
– s
tandard
ised a
ssessm
ent
of
the c
aring s
ituation)
AT
, C
H, E
L,
FR
, IT
, P
T,
SI
BU
, C
Z, D
E,
ES
, IE
, M
T,
NO
, P
L
BE
, C
H,
DE
, D
K, F
I,
HU
, LU
, N
L,
SE
, U
K
BU
, D
E, D
K,
FI, H
U, LU
, M
T, N
L, N
O,
PL, S
E,
UK
ES
, B
E,
IE,
PL
ES
, IE
H
U
Counselli
ng a
nd A
dvic
e
(e.g
. in
fill
ing in form
s for
help
E
L, P
T
BU
, C
Z, D
E,
ES
, F
I, F
R,
IE, IT
, M
T,
NO
, P
L, S
I
AT
, B
E, B
U,
CH
, D
K,
HU
, IT
, LU
,
NL, S
E, U
K
BE
, B
U,
CH
, C
Z, D
E, D
K,
HU
, LU
, M
T,
NO
, U
K
AT
, B
E, C
H,
CZ
, E
S, F
I,
FR
, IE
, IT
, LU
, M
T, P
L,
SE
AT
, C
Z,
DK
, E
S,
DE
, F
R, IE
, IT
, M
T, P
L,
SI, U
K,
AT
, B
U, F
R,
HU
, IE
, M
T,
SI
BU
, D
E, D
K,
FI, F
R, M
T,
PL, U
K
Self-h
elp
support
Gro
ups
BU
, C
H, LU
, M
T
BE
, C
Z, D
E,
DK
, E
L, E
S,
FI, F
R, H
U,
IE, IT
, N
O,
PL, P
T, S
I,
UK
AT
, N
L, S
E
UK
D
E, E
S, F
I,
IT, N
L, P
L,
SE
BE
, C
Z,
DE
, D
K,
ES
, F
I, F
R,
IE, IT
, N
L,
NO
, P
L, S
I,
UK
AT
, B
E, E
L,
FR
, H
U, IE
, IT
, N
L, N
O,
PL, P
T, S
I
AT
, D
E, D
K,
FI, F
R, P
T
“Gra
nny-s
itting”
CH
, M
T, S
I
AT
, B
E, C
Z,
DE
, D
K, F
I,
FR
, IE
, LU
, N
L, N
O, P
L,
PT
, S
E, U
K
BU
, E
L, IT
B
U, D
E, U
K
BE
, F
I, N
L
BE
, C
Z,
DE
, D
K, F
I,
IE, N
L, U
K
BE
, B
U, E
L,
FI, H
U, IE
, LU
, N
O, P
L,
SE
AT
, B
E, D
E,
EL, F
I, F
R,
IT, D
K, P
L,
PT
, U
K
Pra
ctical tr
ain
ing in c
aring,
pro
tecting their o
wn p
hysi-
cal and m
enta
l health, re
-
laxation e
tc.
BU
, D
K
AT
, B
E, C
H,
CZ
, E
L, E
S,
FI, F
R, H
U,
IE, IT
, M
T,
NL, N
O, P
L,
PT
, S
I, U
K
AT
, D
E, LU
, S
E
DE
, LU
, U
K
DE
, E
S, F
I,
IT, N
L, P
L,
SE
AT
, B
E,
CH
, E
L,
ES
, F
I, F
R,
IE, IT
, M
T,
NL, P
T, S
I,
UK
AT
, C
Z, F
R,
HU
, M
T,
NL, N
O, P
L,
PT
FR
, P
T
75
Ava
ilab
ilit
y
Vo
lun
tary
Serv
ices f
or
fam
ily c
are
rs
No
t P
art
ially
To
tally
Sta
tuto
ry
Pu
blic, N
on
sta
tuto
ry
Pu
blic
fun
din
g
No
pu
blic
fun
din
g
Pri
vate
Weekend b
reaks
AT
, B
U, C
Z,
DK
, E
L, M
T,
SI
CH
, D
E,
ES
, F
I, F
R,
IE, IT
, H
U,
NL, N
O, P
L,
PT
, S
E, S
I,
UK
BE
, LU
D
E, F
I, L
U,
SE
, U
K
BE
, E
S,
IT,
NL, P
T
BE
, C
H,
DE
, E
S, IE
,
NL, U
K
HU
, N
L
BE
, D
E, E
S,
FR
, IT
, N
L,
PL, P
T,
UK
Respite c
are
serv
ices
AT
, C
H, C
Z,
DE
, D
K, E
S,
FI, F
R, H
U,
IE, IT
, M
T,
NL, N
O, P
L,
PT
, S
I, U
K
BE
, B
U, LU
, S
E
BU
, D
E, D
K,
FI, IE
, LU
,
MT
, S
E, U
K
AT
, B
E, IT
, E
S, N
L, P
T,
SI
BE
, C
H,
CZ
, F
R, IE
,
NL
AT
, F
R,
HU
, IE
, M
T,
NL, P
T
BE
, C
Z, E
S,
FR
, H
U, IE
, IT
, N
L, P
L,
PT
, S
I
Moneta
ry tra
nsfe
rs
BE
, C
H,
MT
, P
L, P
T,
SI
AT
, D
K, E
S,
FI, F
R, IE
,
NL, N
O, P
T
BU
, D
E, IT
, LU
, S
E
BU
,CZ
, D
E,
DK
, F
I, IE
,
IT, LU
, N
L
AT
, E
S
IE
AT
F
R
Managem
ent of crises
CZ
, D
K, P
T
AT
, B
U, C
H,
EL, E
S,
FR
, IE
, IT
, M
T,
NO
, P
L, P
T,
SE
, U
K
BE
, F
I, H
U,
LU
BE
, D
E, F
I,
FR
, H
U, LU
,
UK
AT
, B
U, E
S,
FR
, IE
, IT
,
PL, S
E
CH
, D
E,
FR
, IE
, IT
,
UK
AT
, B
U, F
R,
HU
, IT
, P
L
CH
, F
R
Inte
gra
ted p
lannin
g o
f care
fo
r eld
erly a
nd fam
ilies (
in
hospital or
at hom
e)
BE
, E
L,
CH
, P
T, S
I
AT
, B
U, C
Z,
DK
, IE
, IT
, M
T, N
L,
NO
, P
L, U
K
FI, H
U, LU
, S
E
DE
, D
K, F
I,
HU
, LU
, M
T,
NL, S
E, U
K
AT
, B
U, F
I,
IE, IT
IE
, P
L
AT
, B
U,
HU
, P
L
Specia
l serv
ices for
fam
ily
care
rs o
f diffe
rent eth
nic
gro
ups
AT
, B
E, B
U,
CH
, C
Z,
DK
, E
L, IE
, IT
, M
T, P
L,
PT
, S
I
DE
, F
I, F
R,
LU
, N
L, N
O,
SE
, U
K
U
K
DE
, F
I, N
L,
SE
D
E, F
I, N
L,
UK
N
L
76
Ava
ilab
ilit
y
Vo
lun
tary
Serv
ices f
or
fam
ily c
are
rs
No
t P
art
ially
To
tally
Sta
tuto
ry
Pu
blic, N
on
sta
tuto
ry
Pu
blic
fun
din
g
No
pu
blic
fun
din
g
Pri
vate
Oth
er
Support
Centr
es for
FC
s
volu
nta
ry h
om
e c
are
and
buddy c
are
, H
U-
-Maltese
Charity
serv
ice
BU
, C
H, P
L
NL, IE
H
U
N
L
HU
, IE
, LU
, N
L
HU
77
5.6
A
nn
ex 6
– M
atr
ix o
f F
am
ily C
are
rs’
Leg
al
Po
sit
ion
an
d R
ec
og
nit
ion
by S
tate
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
Austr
ia
Spouses legally r
espon-
sib
le for
one a
noth
er.
In
som
e p
rovin
ces a
nd d
e-
fined lim
its O
P c
an d
e-
mand m
ain
tenance fro
m
descendants
. C
hildre
n
have to c
ontr
ibute
fin
an-
cia
lly in m
ost
pro
vin
ces
under
socia
l assis
tance
law
s f
or
costs
of com
mu-
nity s
erv
ices / r
esid
ential
care
. E
xclu
des V
ienna
where
fili
al oblig
ation
abolished.
Incohere
nt re
gula
tions in
diffe
rent pro
vin
ces, de-
gre
e o
f enfo
rcem
ent is
variable
. S
upre
me A
dm
in
Court
and o
ther
legal
bodie
s h
ave m
ade d
eci-
sio
ns o
n w
hen p
rovin
cia
l
bodie
s c
an d
em
and c
ost
contr
ibution fro
m f
am
ily.
Pre
fere
ntial in
sura
nce
term
s f
or
non-e
mplo
yed
pro
vid
ing L
TC
. S
elf-
insura
nce u
nder
health
and p
ensio
n insura
nce
schem
es; fr
ee n
on-
contr
ibuto
ry c
o-insura
nce
with s
ickness b
enefits
to
care
rs in r
eceip
t of LT
C
allow
ance levels
4-7
.
1998 F
C a
cknow
ledged
in L
TC
Act – g
et pensio
n
contr
ibutions, sta
te p
ays
em
plo
yer
contr
ibutions.
Work
ing c
are
rs –
cla
im
max 1
week p
.a. fo
r re
la-
tive in c
om
mon h
ouse-
hold
. P
ossib
ility
of gettin
g
reduced w
ork
ing H
rs b
ut
only
1%
Co.s
have fam
ily
frie
ndly
policie
s –
main
ly
for
hig
hly
qualif
ied. 2002
com
passio
nate
leave for
dyin
g –
6 m
onth
pro
tec-
tion fro
m d
ism
issal- u
n-
paid
.
Federa
l LT
C a
llow
ance
1993 –
sin
gle
case b
ene-
fit to
com
pensate
for
care
rela
ted a
dditio
nal ex-
penses –
7 d
iffe
rent le
v-
els
- c
onsum
er
directe
d.
Sta
tuto
ry e
ntitlem
ent. N
ot
means t
este
d.
Hig
h s
ocia
l expecta
tion o
f
filia
l and s
pouse c
are
. D
e
facto
most
care
fro
m
fam
ilies b
ut w
om
en w
ith
care
ers
less w
illin
g to
care
.
Attem
pts
to c
hange s
ocia
l
attitudes o
f em
plo
yers
by
the F
am
ily a
nd W
ork
Audit.
Little c
o-o
rdin
ation a
nd
co-o
pera
tion b
etw
een
fam
ily m
em
bers
and s
er-
vic
e p
rovid
ers
.
Belg
ium
(Note
diffe
r-
ences b
etw
een
Wallo
on a
nd
Fin
ancia
l re
sponsib
ilities
but not to
pro
vid
e c
are
–
may inclu
de e
ven g
rand-
childre
n f
or
costs
of
resi-
dential care
.
Public
Centr
e for
Socia
l
Welfare
can r
ecla
im c
osts
of re
sid
ential care
fro
m
fam
ily
Yes
LT
CI exis
ts in F
lem
ish
part
plu
s incentives to F
C
for
care
of th
ose a
ged
70+
. P
ays for
non m
edi-
cal costs
and s
om
e L
As
Incre
asin
g p
ublic a
c-
know
ledgm
ent of th
eir
role
. O
P p
erc
eiv
e f
am
ilies
as less w
illin
g to c
are
.
How
ever
FC
still
critical.
78
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
Fle
mis
h a
rea)
giv
e e
xtr
a c
om
pensation
to F
Cs. V
ariations b
e-
tween r
egio
ns. W
alloon
are
a L
TC
I does n
ot exis
t.
Bulg
aria
Yes
Socia
l serv
ices c
annot
easily c
ollect
costs
of
care
back fro
m r
ela
tives if
not w
ell o
ff.
No
No
Socia
l expecta
tion, but
with m
ass e
mig
ration a
nd
inadequate
serv
ices,
there
are
pro
ble
ms.
Czech R
epub-
lic
Rig
hts
and o
bligations o
f
FC
s n
ot le
gally d
efined.
OP
Rig
ht to
health c
are
/
no r
ight to
socia
l care
favours
institu
tionalis
ation
and d
iscrim
inate
s a
gain
st
FC
– a
lso s
yste
m o
f re
-
imburs
em
ent of G
P c
are
favours
hospital vs. hom
e
care
and G
Ps “
reje
ct”
dependent O
P a
nd their
fam
ily c
are
rs
Pensio
n c
redits f
or
rela
-
tive’s
care
Paid
care
r’s a
llow
ance to
care
for
sic
k f
am
ily m
em
-
ber
if u
nable
to w
ork
due
to c
aring d
uties –
(1st 9
days x
1 for
dia
gnosis
) –
com
ple
x s
yste
m b
ut used
in a
reas o
f hig
h u
nem
-
plo
ym
ent
1)
Am
biv
ale
nt attitudes to
FC
by O
P a
nd F
Cs d
ue
to c
onflic
ts o
ver
respon-
sib
ilities b
etw
een s
tate
and f
am
ily (
socia
list vs.
traditio
nal).
2)
FC
s a
ct as m
anagers
of care
arr
angem
ents
Denm
ark
N
o
No
legis
latively
stipula
ted
rights
are
the r
ight to
com
pensation f
or lo
st
earn
ings in c
ase o
f caring
for
a d
yin
g r
ela
tive, and
the r
ight to
em
plo
ym
ent
as a
care
r w
hen c
ert
ain
conditio
ns a
re m
et
No –
welfare
sta
te funds
all
pro
vis
ions.
No r
ole
; no e
xpecta
tion.
But in
cre
asin
g r
ole
and
recognitio
n o
f F
am
ilial
netw
ork
s
Fin
land
No fam
ily o
blig
ation. Le-
gal oblig
ation o
f sta
te v
ia
munic
ipalit
y to p
rovid
e
care
for
dependent O
P
No
Yes, cle
arly d
efined in
Socia
l W
elfare
Act. D
ays
off, re
hab a
nd r
ela
xation.
Variety
of
pro
jects
.
Yes, by m
unic
ipalit
y –
als
o Inju
ry Insura
nce!!
Taxable
. A
mount varies
Attendant C
are
rs A
llow
-
ance. M
in 2
29,2
9 €
Yes, fo
rmal and legal
recognitio
n o
f care
r
sta
tus a
s p
art
of
socia
l
and h
ealth s
erv
ices D
e-
sire b
y O
P a
nd s
tate
to
incre
ase this
Fra
nce
Yes, spouses b
ut under
LA
can d
educt costs
in-
Means teste
d b
enefits
for
Tax b
enefits
m
ora
l expecta
tion o
f F
C –
79
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
civ
il code c
hild
ren a
re
obliged to m
ain
tain
their
moth
er,
fath
er
and o
ther
ascendants
3
curr
ed in c
are
of
OP
fro
m
inherita
nce
those 6
0+
national allo
w-
ance o
f dependency
(AP
A)
to O
P.
If F
C takes s
ala
ry t
hen
there
are
pensio
n c
ontr
i-
butions p
aid
.
AP
A b
eneficia
ries =
605,0
00
by p
olic
ym
akers
, socie
ty
as w
ell a
s p
ote
ntial and
active f
am
ily c
are
rs
share
, based o
n
the c
oncept of m
ora
l obli-
gation d
ue to o
ne’s
spouse a
nd o
ne’s
old
pare
nts
.
Germ
any
Yes. F
ilial oblig
ation, but
means teste
d
Means teste
d
Yes –
pensio
n, (5
80,0
00
FC
s u
nder
LT
CI)
cours
es
in c
are
giv
ing. T
ax b
ene-
fits
. R
ights
to leave for
short
periods o
r fo
r up to
one y
ear
and c
an b
e
gra
nte
d w
ith o
r w
ithout
wage a
dju
stm
ent. N
ew
–
only
few
larg
e C
os a
llow
flexib
le h
ours
or
job s
har-
ing
LT
C A
llow
ance. T
axable
.
Am
ount varies.
Atten-
dance A
llow
ance o
f m
in
230 €
.
71%
of th
ose n
eedin
g
care
dra
w b
enefits
in
cash &
org
aniz
e c
are
them
selv
es;
12%
dra
w
benefits
in k
ind a
nd u
se
pro
fessio
nal serv
ices a
nd
15%
com
bin
e b
enefits
in
kin
d a
nd in c
ash
Socia
l assum
ption o
f F
C
and legis
lative s
upport
for
fam
ily e
thic
. C
lass d
iffe
r-
ences in c
are
– L
/ c
less
accepting o
f re
sid
ential
care
. D
ecre
ase in a
s-
sum
ption o
f caring for
pare
nts
or
part
ner.
LT
CI
does n
ot in
cre
ase s
ocia
l
solidarity
. D
esire b
y O
P
and s
tate
to incre
ase this
.
Gre
ece
Yes in C
onstitu
tion
Not enfo
rceable
in p
rac-
tice
No, m
inim
al (6
days)
care
leave for
child
ren a
nd
dependent O
P (
eff
ec-
tively
sta
te e
mplo
yees
only
)
No. T
ax r
elie
f if c
o-
resid
ent and d
ependent
Socia
l expecta
tion to c
are
without re
cognitio
n o
f ro
le
Hungary
W
as o
bligato
ry b
etw
een
spouses a
nd g
enera
tions.
Fam
ily A
ct 1952, 1986
LA
s h
ave c
are
and fin
an-
cia
l re
sponsib
ility
for
OP
– r
egio
nal variations
Ltd
, le
ss than 4
hrs
work
p.d
. can g
et nurs
ing fee
but
low
level. (
may n
ot
be
less than 6
0%
of
old
age
pensio
n)
Must pay p
en-
sio
n c
ontr
ibution fro
m
this
.
LA
pays. N
o fin
ancia
l
incentive to c
are
. Low
take u
p
Socia
l expecta
tion to c
are
exte
nds to w
ider
socie
ty.
But shift to
more
form
al
support
for
OP
+ n
ew
serv
ices.
OP
often m
istr
usts
oth
ers
inclu
din
g r
ela
tives. F
C
80
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
receiv
ing n
urs
ing c
are
fee
often s
uspic
ious o
f fo
rmal
serv
ices.
Irela
nd
None
No s
tate
responsib
ility
either
Iris
h H
ealth B
oard
s in-
clu
ded the m
eans o
f adult
childre
n in a
ssessin
g
eligib
ility
of O
P for finan-
cia
l support
for
the c
osts
of nurs
ing h
om
e c
are
–
now
judged c
ontr
ary
to
rele
vant sta
tuto
ry r
egula
-
tions.
Pensio
n c
redits o
nly
available
dependin
g o
n
receip
t of C
are
rs’ A
llow
-
ance. In
adequate
cover-
age o
f costs
, C
are
rs
Benefits
taxable
. M
ax.
139.7
€, p.w
. 209.6
for
2.
Elig
ible
for
retu
rn to E
du-
cation a
llow
ance w
hen
caring r
esponsib
ilities
end.
Respite g
rant.
Care
r’s C
hart
er
Tax b
ased p
rovis
ions f
or
care
rs. T
ax r
elie
f and
medic
al expenses.
Only
600 g
ot C
are
rs’
Benefit (if ta
kes tim
e o
ut
from
em
plo
ym
ent)
– n
ot
every
one is e
ligib
le.
Fin
ancia
l support
most
import
ant is
sue f
or
FC
s.
Care
rs A
llow
ance m
eans
teste
d –
129.1
4 €
p.w
.
Socia
l expecta
tion to c
are
with incre
asin
g r
ecogni-
tion o
f ro
le. C
hanges w
ith
the r
ise o
f th
e 2
incom
e
fam
ily a
nd r
isin
g e
m-
plo
ym
ent le
vels
.
No info
rm o
n m
inorities
and c
are
.
Italy
Y
es to the third d
egre
e; a
fam
ily m
em
ber
requirin
g
assis
tance, can a
sk f
or
‘alim
ony’ fr
om
the f
am
-
ily58,
who m
ay f
ulfil
this
obligation e
ither
by p
ay-
ing a
n a
mount of m
oney
each m
onth
or
by a
ccept-
ing a
nd s
upport
ing the
pers
on n
eedin
g a
ssis
-
tance in their o
wn h
ouses
(art
icle
s 4
33, 438, 443 o
f
Art
icle
570 o
f th
e P
enal
Code p
rovid
es f
or
the
offence o
f “v
iola
tion o
f th
e
obligations o
f fa
mily
as-
sis
tance”
for
those w
ho
negle
ct subsis
tence to
the r
ele
vant re
latives,
incapable
of w
ork
ing, etc
No c
ase law
quote
d b
ut
de facto
pre
ssure
on
rela
tives to p
ay for
ad-
mis
sio
n to r
esid
ential or
Som
e-
especia
lly in p
ub-
lic s
ecto
r, h
ave r
ight of
continuous o
r split unpaid
leave u
p to tw
o y
ears
,
this
period o
f le
ave is n
ot
calc
ula
ted e
ither
in the
length
of serv
ice o
r in
the
socia
l-in
sura
nce s
chem
e.
Few
in p
rivate
secto
r use
this
rig
ht.
Not nationally
. A
t LA
level
ltd. econom
ic c
ontr
ibu-
tions f
or
FC
caring f
or
dependent O
P a
t hom
e
as c
ash c
are
allo
wances
based o
n n
eed a
nd in-
com
e (
the S
tate
care
allow
ance is g
rante
d o
nly
on the b
asis
of
necessity,
bein
g n
on-m
eans-t
este
d).
Regio
nal variations e
.g.
specia
l vouchers
in L
om
-
Assum
ption o
f F
C b
ut
ideolo
gic
al syste
m o
n the
fam
ily is c
hangin
g. S
till
caring in t
he fam
ily is
consid
ere
d a
s the b
est
solu
tion P
rivate
ly p
aid
hom
e c
are
keeps o
n
gro
win
g d
ue to the w
eak-
enin
g o
f th
e c
are
oblig
a-
tions o
f fa
mili
es a
nd to a
public s
yste
m c
onfined to
pla
y a
resid
ual ro
le o
f
58
These p
ers
ons, id
entified b
y law
, are
in the o
rder:
spouse; le
gitim
ate
, le
gitim
ized, natu
ral or
adopte
d c
hild
ren, and, if they a
re lackin
g, to
the c
losest
descendants
; pare
nts
and, if they a
re m
issin
g, th
e c
losest ancesto
rs e
ven n
atu
ral, a
nd a
dopte
rs; sons a
nd d
aughte
rs-in-law
; fa
ther-
and m
oth
er-
in-law
; bro
thers
and s
iste
rs, G
erm
an o
r half w
ith the form
er
havin
g p
recedence o
ver
the latter.
81
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
the C
ivil
Code).
hospital and s
ocia
l care
.
bard
y. M
ilan.
328 / 2
000 a
fis
cal polic
y
intr
oduces tax c
onces-
sio
ns f
or
fam
ilies w
ith
specia
l care
burd
ens, to
overc
om
e the p
roble
m o
f
care
that is
tota
lly d
is-
burs
ed b
y p
ublic s
er-
vic
es, and to d
iscoura
ge
irre
gula
r fo
rms o
f care
work
+ o
ther
tax d
eductible
costs
.
funder
(i.e
. of financin
g
care
), s
uch that now
a-
days this
repre
sents
the
main
sourc
e for
obta
inin
g
care
serv
ices, once the
pro
vis
ion o
f fa
mily
care
is
no longer
possib
le. It is
larg
ely
an info
rmal m
ar-
ket, w
hic
h a
lso e
xis
ts
because it evades p
ublic
regula
tions, but is
more
or
less e
xplic
itly
sup-
port
ed b
y the s
tate
.
Luxem
bourg
N
o
No
Yes c
ontr
ibutions to p
en-
sio
n f
unds o
nly
.
H
igh institu
tional pro
vi-
sio
n. E
merg
ence o
f new
attitudes t
o s
upport
OP
at
hom
e. S
mall
countr
y a
nd
pro
xim
ity to fam
ily –
as-
sum
ed fam
ily s
upport
but
no d
eta
ils o
n a
ctu
al socia
l
attitudes t
o F
.care
. D
e-
velo
pm
ent of re
spite c
are
suggest in
cre
asin
g r
ec-
ognitio
n o
f F
Cs. A
nd their
need f
or
support
.
Malta
Yes-
non m
ain
tenance o
f
pare
nt deducte
d fro
m
futu
re inherita
nce
Very
rare
N
ot rights
but de facto
respite c
are
Care
rs p
ensio
n’- 7
0 €
+
weekly
– c
ohabitin
g, fo
r
very
dependent. M
eans
teste
d S
ocia
l A
ssis
tance
for fe
male
s c
aring.
Means teste
d.
VA
T r
elie
f on thin
gs u
sed
by c
are
rs.
Not fo
rmally
recogniz
ed
but fa
mily
has p
riority
in
socia
l polic
y a
nd s
upport
serv
ices.
Assum
ed it
was
fem
ale
duty
, new
valu
es,
men h
elp
fin
ancia
lly. 41%
of th
ose w
ith c
are
rs p
en-
sio
n a
re m
en. C
hanges in
82
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
wom
en’s
role
s, sm
all
fam
ilies r
ecogniz
ed a
s
meanin
g d
ifficultie
s for
FC
s.
Neth
erlands
NO
– G
ovt. a
nd p
ublic
assum
es it
No c
ase law
on the r
ights
and o
bligations o
f F
Cs.
Negotiation w
ith n
eeds
assessm
ent agency a
s to
what is
extr
a c
are
for
FC
.
Many -
Fin
ancin
g C
are
er
bre
ak (
sin
ce 1
998)
off
ers
the p
ossib
ility for
a p
alli
a-
tive c
are
leave.
Sin
ce
2002 b
roadened, but
com
pensation is low
and
e m
any r
ule
s a
nd c
ondi-
tions t
hat
do n
ot
stim
ula
te
people
to a
rrange this
kin
d o
f care
leave. M
inis
-
try s
upport
FC
S thru
’
needs a
ssessm
ent,
stim
ula
tion o
f volu
nta
ry
work
, crisis
care
, re
spite
care
, m
onitoring o
f th
e
effect of
info
rmal care
,
financia
l aspects
, com
bi-
nation o
f w
ork
and info
r-
mal care
, and r
ais
ing
more
attention f
or in
for-
mal care
am
ong p
rofe
s-
sio
nal care
giv
ers
.
Yes –
13%
of
FC
s w
ith
extr
a e
xpenses r
eceiv
e
financia
l com
pensation,
of w
hic
h 7
3%
fro
m the
care
receiv
er.
(P
ers
onal
Care
Budget)
Only
6%
from
socia
l security
, 6%
via
taxes, and 2
0%
men-
tioned a
n u
nknow
n
sourc
e. O
n a
vera
ge the
com
pensation w
as 2
85 €
in 2
001,
Incom
e t
ax m
easure
s
80%
assum
e F
C a
s a
matter
of cours
e –
though
OP
less. R
ecent changes
in h
ealth c
are
im
plic
ate
FC
s w
ho a
re e
xpecte
d to
pro
vid
e m
ore
care
for
their r
ela
tives.
Norw
ay
no legal oblig
ations o
f
caring b
etw
een a
dult
genera
tions
No
Pensio
n / c
redit r
ights
-
all
care
rs a
re g
iven p
en-
sio
n p
oin
ts -
3 a
year
(corr
espondin
g to a
wage
cle
arly b
elo
w a
vera
ge).
1,8
50 p
ers
ons r
eceiv
ed a
munic
ipal care
wage f
or
care
of O
P –
irr
espective
of in
com
e-
but difficult to
get, h
as t
o involv
e h
eavy
duties a
nd m
ost F
Cs
don’t a
pply
for
it. B
ut
30,1
32 p
ers
ons a
ged 6
5+
'Welfare
sta
te o
rienta
tion'
= e
xpecta
tions a
bout
rela
tive r
esponsib
ilities o
f
the w
elfare
sta
te a
nd the
fam
ily in the 3
dom
ain
s o
f
socia
l polic
ies a
nd s
er-
vic
es for
old
er
people
:
financia
l support
, in
str
u-
83
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
receiv
ed a
ssis
tance p
en-
sio
n fro
m the N
ational
socia
l security
board
in
2002 f
or
those n
eedin
g
care
due to long-t
erm
illness, in
jury
or
impair-
ment.
menta
l help
and p
ers
onal
care
. A
pers
on's
'pre
fer-
ences f
or
care
' are
a
com
pro
mis
e b
etw
een
norm
ative c
onsid
era
tions
and p
ers
onal pre
fere
nces
Pola
nd
Yes, financia
l oblig
ations
(allow
s f
or fa
mily
inte
r-
dependence)
–sta
te o
bli-
gations o
nly
to “
fam
ilies
with d
ifficult s
ocia
l and
mate
rial situation”
(de-
fined)
via
LA
s
Yes, als
o w
ith join
t le
gal
agre
em
ent on inherita
nce
in e
xchange for
care
.
Em
plo
yed F
Cs o
f dis
-
able
d (
all
ages)
have the
right to
2 / 5
2 leave (
not
self-e
mplo
yed)
Not to
care
r but “a
tten-
dance a
llow
ance”
for
ALL >
75s
Socia
l expecta
tion to c
are
without re
cognitio
n o
f ro
le
Port
ugal
Constitu
tional right after
1974 to s
ocia
l pro
tection
from
sta
te.
In C
ivil
Law
Code d
e-
scendants
obliged b
y law
to p
rovid
e for
their a
s-
cendants
– s
ocia
l security
policy o
pera
tes w
hen
they c
annot pro
vid
e s
uch
care
.
Civ
il rights
to p
rote
ct O
P
– r
ight to
suste
nance
under
str
ong p
rote
ction
(Art
. 2003)
for
suste
-
nance, housin
g, clo
thin
g,
Art
icle
2009 N
o.1
b a
lso.
Public
em
plo
yees r
ight to
15 d
ays p
er
year
under
the c
over
of
‘fam
ily m
edi-
cal cert
ific
ation’ to
care
for
OP
– b
ut in
private
secto
r only
available
for
care
of
those u
nder
10
years
.
No.
Fin
ancia
l help
only
to
dependent O
P w
ho m
ay
use it
to p
ay F
C
Recip
rocity in fam
ilies,
Socia
l expecta
tion to c
are
without re
cognitio
n o
f
role
,
Indirect sta
te s
upport
e.g
.
day c
are
centr
es, health
centr
es.
Socia
l pre
ssure
accom
-
panie
d b
y h
ostilit
y to-
ward
s institu
tions. S
ocia
l
change in a
ttitudes w
ith
oth
er
pre
ssure
s p
lus in-
cre
ased s
ocia
l pro
vis
ion.
Gra
dual develo
pm
ent of
part
ners
hip
betw
een f
or-
mal and info
rmal care
rs.
Slo
venia
Y
es
for adult c
hild
ren a
nd
step c
hild
ren if pare
nts
/
steppare
nts
cannot w
ork
Polic
y a
nd p
lannin
g to
support
dependent O
P
bein
g d
evelo
ped, in
clu
d-
7-1
4 d
ays / y
ear
paid
com
pensation f
or
nurs
ing
sic
k c
o-h
abitin
g c
lose
New
Act fo
r dis
able
d
(may inclu
de O
P)
to
choose a
“fa
mily
assis
-
1)
See a
s for
Czech
above. 2)
Als
o, pare
nts
substa
ntially
help
young
84
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
and d
o n
ot have s
uffic
ient
funds
for liv
ing. F
inancia
l
obligation to s
upport
e.g
.
costs
of
resid
ential care
,
but no legal oblig
ation to
care
, although “
unw
ritten
rule
” fo
r at le
ast te
mpo-
rary
FC
ing h
om
e h
ealth c
are
. fa
mily
mem
bers
. ta
nt”
(obligato
ry tra
inin
g)
with p
art
ial paym
ent fo
r
loss o
f w
ork
– a
pplie
s to
OP
in c
ert
ain
cases, w
ith
crite
ria b
ein
g d
efined.
Attendance a
llow
ance
paid
to p
ers
on (
inclu
din
g
dependent O
P)
needin
g
consta
nt care
.
fam
ilies –
OP
with p
rop-
ert
y w
ant to
leave it to
childre
n a
nd w
on’t s
ell,
but not alw
ays a
ccom
pa-
nie
d b
y r
ecip
rocity in c
are
by c
hild
ren. P
eople
be-
lieve t
he S
tate
will
take
care
of
every
thin
g.
“Socie
ty takes F
C for
gra
nte
d a
nd they d
o n
ot
exis
t as far
as p
olit
icia
ns
are
concern
ed.”
Spain
Y
es,
Spanis
h c
ivil
regula
-
tions a
ssig
n the r
espon-
sib
ility
for
attendin
g a
nd
caring for
the d
ependent
eld
er
on the s
pouse a
nd
childre
n (
Spanis
h C
ivil
Code.
Book I
). -
spouses
and a
ll ascendants
and
descendants
are
recip
ro-
cally
oblig
ed to g
ive
main
tenance p
roport
ion-
ate
to the m
eans o
f th
e
donor
and the n
eeds o
f
the r
eceiv
er.
Infr
ingem
ent to
fulfil
legal
duties o
f assis
tance w
ill
be p
unis
hed w
ith a
rrest
from
eig
ht to
tw
enty
weekends (
Spanis
h P
e-
nal C
ode)
.
FC
not re
cogniz
ed. ord
i-
nance. (L
aw
39 / 1
999,
Concili
ation o
f fa
mily
and
work
ing life)
conte
m-
pla
tes the r
ight to
a r
e-
duction in the w
ork
ing
day w
ith a
pro
port
ional
reduction o
f sala
ry, and /
or
leave for
a tim
e n
ot
exceedin
g o
ne y
ear
to
look a
fter
a r
ela
tive w
ho,
for
reasons o
f age, is
unable
to look a
fter
him
/
hers
elf.
40%
of F
C h
om
es g
et
under
600 €
p.m
. R
e-
gio
nal G
ovts
may g
ive
fam
ily s
ubsid
ies. e.g
.
Aut.C
om
Madrid g
ives
cash a
id to F
Cs if a
nnual
incom
e o
f th
e fam
ily is
under
9,2
86 €
and O
P
very
dis
able
d. T
he m
ax.
am
ount of aid
is 2
,710 €
p.a
.
Tax r
eductions -
by a
ge
and f
or
expenses a
ssoci-
ate
d w
ith the a
ssis
tance
of th
e e
lderly o
r dis
able
d
when the taxpayer
is o
ver
65
Expecte
d a
nd few
ser-
vic
es.
Attention t
o F
Cs is
very
recent.
Sw
eden
No s
tatu
tory
responsib
ility
for
childre
n to p
rovid
e
care
or
econom
ic s
upport
for
their f
am
ily m
em
bers
NO
Y
es, C
are
Leave A
ct
(1989)
pro
vid
es r
ight to
paid
leave for
those u
n-
der
67 y
ears
and in the
Yes, plu
s the inte
gra
tion
of care
r support
into
the
form
al care
managem
ent
syste
m A
ttendance a
l-
The r
e-d
iscovery
of F
C
follo
win
g d
ecades o
f ex-
pecta
tions that th
e s
tate
will pro
vid
e a
ll necessary
85
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
labour
forc
e for
up to 6
0
days to a
ttend to a
fam
ily
mem
ber
in a
term
inal
care
situation. C
overe
d
under
National S
ocia
l
Insura
nce a
t th
e s
am
e
level as s
ickness p
ay-
ment
low
ance: an u
nta
xed
cash p
aym
ent to
the d
e-
pendent, u
sed to p
ay the
fam
ily m
em
ber
for
her
help
. T
he m
onth
ly p
ay-
ment is
modest
(SE
K
5 0
00 / m
onth
(~ 5
50 €
).
serv
ices f
or
OP
– C
are
r
300 p
roje
ct
Sw
itzerland
Variations b
y C
anto
ns
O
P is f
unded a
nd m
akes
decis
ions. A
ssum
ption o
f
FC
with p
rincip
le o
f sub-
sid
iarity
, w
here
the fam
-
ily, th
e indiv
iduals
take
their o
wn r
esponsib
ility
in
term
s o
f care
. T
he s
tate
inte
rvenes o
nly
when the
fam
ily c
annot find a
ny
oth
er
altern
ative P
olic
ies
are
still
to the im
port
ance
of F
C a
nd h
ave n
ot re
ally
gra
sped the s
cope o
f th
e
issue, neither
in e
co-
nom
ic term
s,
neither
in
socie
tal te
rms.
UK
N
o
No
N.I. C
redit p
aid
for
every
week F
C g
ets
Invalid
Care
Allo
wance (
unle
ss
they e
lecte
d to p
ay the
low
er
'marr
ied w
om
an's
sta
mp' som
e y
ears
ago).
Or
Hom
e R
esponsib
ilities
Pro
tection for
every
com
-
ple
te y
ear
a F
C c
are
d for
Yes. S
evera
l w
holly o
r
part
ly m
eans teste
d in-
clu
des C
are
rs A
llow
ance,
Invalid
Care
Allo
wance.
FC
s m
ay c
laim
£ 4
3.1
5 a
week; C
are
r P
rem
ium
, an
additio
nal sum
of
up to
£ 2
5.8
0 a
week p
aid
as
part
of In
com
e S
upport
,
Indiv
idual decis
ions –
dependin
g o
n O
P a
nd
fam
ily r
ela
tions. N
o p
ublic
assum
ption o
f F
C though
wid
espre
ad.
86
Co
un
try
Leg
al O
blig
ati
on
L
eg
al E
nfo
rcem
en
t o
f
Du
ties o
f F
C
Rig
hts
of
FC
- p
en
sio
n,
leave
Fin
an
cia
l re
co
gn
itio
n
Ro
le o
f F
C a
nd
so
cia
l
att
itu
des
som
eone p
rovid
ed they
are
gettin
g A
ttendance
Allo
wance o
r D
isabili
ty
Liv
ing A
llow
ance c
are
com
ponent at th
e m
iddle
or
hig
her
rate
. T
his
pro
-
tects
the s
tate
pensio
n.
Vouchers
– issued b
y L
A
entitlin
g F
C to leave b
y
payin
g for
pro
f. C
are
.
incentives to h
elp
care
rs
get
back t
o w
ork
. S
om
e
form
er
FC
s a
re e
ntitled to
Housin
g B
enefit and
Council T
ax B
enefit
or
Rate
Rebate
for
4 w
ks
after
they g
o b
ack to
work
. E
mplo
yers
who
take o
n form
er
FC
s c
an
som
etim
es b
enefit fr
om
payin
g less N
.I. at firs
t.
Additio
nal P
ers
onal T
ax
allow
ance f
or
marr
ied
men w
ith d
ependant chil-
dre
n a
nd w
hose w
ives
are
severe
ly p
hysic
ally
or
menta
lly d
isable
d
thro
ughout th
e tax y
ear.
Incom
e B
ased J
ob S
eek-
ers
Allow
ance, H
ousin
g
Benefit and C
ouncil
Tax
Benefit. F
rom
Oct
2002
people
over
65 c
an m
ake
a c
laim
for
the c
are
rs’
allow
ance, but if h
ave
pensio
n the s
am
e o
r
hig
her
than the IC
A r
ate
will not get allo
wance b
ut
may b
e e
ntitled to the
Care
rs p
rem
ium
if
they
are
on a
low
incom
e.
Direct P
aym
ents
to F
Cs
from
Socia
l serv
ices c
an
only
be s
pent on g
ettin
g
the s
upport
the c
are
r has
been a
ssessed a
s n
eed-
ing.
87
5.7
A
nn
ex 7
– M
atr
ix R
esid
en
tial C
are
Serv
ices (
Insti
tuti
on
al
care
, in
clu
des
resid
en
tial
ho
mes,
nu
rs-
ing
ho
me
s,
sh
ort
an
d l
on
g t
erm
ca
re h
os
pit
als
)
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Au
str
ia
Resid
en
tial care
– N
o g
row
th 1
7%
of
all
wom
en a
ged 8
5+
use s
uch c
are
. 68,5
11
pla
ces in s
enio
r and n
urs
ing h
om
es a
ge
60 +
in 7
40 institu
tions; about 49,8
00
"nurs
ing”
beds in o
ld a
ge a
nd n
urs
ing
hom
es a
nd 1
8,0
04 p
laces in r
esid
ential
care
for
less f
rail
eld
erly; als
o o
ld-a
ge
hom
es, have s
om
e n
urs
ing b
eds, th
us
dis
tinction b
etw
een o
ld a
ge a
nd n
urs
ing
hom
es im
possib
le A
ppro
x. 40,0
00 w
om
en
and 1
1,0
00 m
en in O
P’s
hom
es o
r nurs
ing
hom
es; P
roport
ions o
f O
P u
nchanged
sin
ce the 1
960s a
nd n
o m
ajo
r gro
wth
in
institu
tional care
expecte
d.
Resp
ite –
gro
wth
Sh
elt
ere
d h
ou
sin
g -
gro
wth
Ho
sp
ital sta
y –
declin
e in
len
gth
of
sta
y
OP
60+
= 5
3%
; 75+
= 2
6%
of to
tal sta
ys
in h
ospitals
Reh
ab
ilit
ati
on
– h
om
e s
erv
ice
Ho
sp
ice –
pallia
tive c
are
– y
es,
new
develo
pm
ents
resid
ential and a
t hom
e.
Dem
en
tia –
move a
way f
rom
‘old
’ in
stitu
-
Yes -
LT
C A
llow
ance.
+ u
p to 8
0%
of pen-
sio
n u
sed to fin
ance
public r
esid
ential
care
.
Dependent pers
ons
(defined b
y the c
rite
-
ria f
or
long-t
erm
care
benefits
) have a
legal
right to
adm
issio
n to
public r
esid
ential care
regard
less o
f in
com
e.
Most re
sid
ents
are
beneficia
ries o
f lo
ng-
term
care
allo
w-
ances.5
9 P
aym
ent to
the a
gency b
earing
the c
osts
, usually the
pro
vin
cia
l auth
ority
.
The b
ala
nce is p
aid
as p
ocket m
oney.
Insura
nce F
unds
handle
75%
of
the
financin
g o
f care
39%
of nurs
ing h
om
e
NO
. C
are
r doesn’t
pay
Main
ly u
nm
arr
ied
and / o
r child
less O
P
in h
om
es. N
o tra
ditio
n
of coopera
tion b
e-
tween F
C a
nd s
taff
Lack o
f nation-w
ide
regula
tions a
nd s
tan-
dard
s. In
part
icula
r,
hom
e h
elp
ers
, geriat-
ric a
ides a
nd fam
ily
help
ers
are
tra
ined o
n
the b
asis
of re
gio
nal
regula
tions. A
dditio
n-
ally
, th
ere
exis
t cur-
ricula
develo
ped b
y
non-p
rofit pro
vid
ers
.
The p
rovin
cia
l au-
thorities a
re r
esponsi-
ble
for
the c
onstr
uc-
tion, up-k
eep a
nd
opera
tion o
f nurs
ing
hom
es a
nd to g
uara
n-
tee m
inim
um
sta
n-
dard
s
Ltd
to r
atio o
f clie
nts
/
care
rs +
com
pla
ints
NG
Os h
ave inte
rnal
contr
ols
This
is d
esired b
y O
P
and F
C
59
For
insta
nce, in
Low
er
Austr
ia m
ore
than h
alf o
f all
resid
ents
are
cla
ssifie
d in long-t
erm
care
level 4 o
r hig
her;
only
6 %
of
all
resid
ents
do n
ot re
ceiv
e
long-t
erm
care
allo
wances (
Löger,
Am
ann, 2001: 67).
88
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
tional care
expenditure
s a
re
covere
d b
y c
ontr
ibu-
tions.
Belg
ium
R
esid
en
tial care
– 1
,875 r
est hom
es for
84,1
93 p
eople
with lim
ited d
isabili
ties a
nd
896 n
urs
ing h
om
es for
28,6
70 p
eople
with
majo
r dis
abili
ties. M
any r
est hom
es a
nd
nurs
ing h
om
es h
ave w
aitin
g lis
ts, espe-
cia
lly those n
urs
ing h
om
es w
ith w
ard
s f
or
people
suff
ering fro
m d
em
entia.
Crite
ria for
adm
issio
n -
Multi-dis
cip
linary
evalu
ation r
eport
s a
nd s
tandard
ized
evalu
ation s
cale
s u
sed f
or
adm
issio
n-
str
ict crite
ria inclu
din
g n
eed f
or
help
with
AD
L, in
abili
ty to liv
e a
t hom
e.
Som
e
hom
es a
dm
it, oth
ers
exclu
de p
eople
with
dem
entia.
Majo
rity
are
private
not fo
r pro
fit.
Resp
ite c
are
within
122 c
entr
es in n
urs
-
ing h
om
es in the F
lem
ish R
egio
n. In
Wal-
loon R
egio
n, alm
ost no r
espite c
are
.
Sh
elt
ere
d h
ou
sin
g –
fo
r d
em
en
tia +
?
Ho
sp
ital sta
y g
eriatr
ic w
ard
beds d
e-
cre
ased R
ehabili
tation?
Ho
sp
ice –
pallia
tive c
are
Dem
en
tia –
yes s
pecia
l w
ard
s, plu
s inno-
vato
ry s
mall
units –
canto
us –
see F
rance. C
osts
av. M
onth
ly
€ 9
91.5
7. H
igher
than
wages a
nd d
iffe
rence
gro
win
g.
35%
rest
hom
es /
45%
nurs
ing h
om
es /
80%
HC
serv
ices a
nd
100%
hom
e n
urs
ing
financed b
y p
ublic –
tax a
nd s
ocia
l contr
i-
butions, F
ed. G
ovt
com
pensate
s f
or
de-
pendent 65+
takin
g
into
account and
household
liv
ing in a
poin
t scale
.
Fle
mis
h –
com
pensa-
tion for
non m
edic
al
costs
.
Som
e w
ill n
eed h
elp
from
rela
tives to fi-
nance their s
tay. M
ay
get
benefits
fro
m the
Public
Centr
e for
Socia
l W
ork
whic
h
can try
to g
et re
im-
burs
em
ent fr
om
the
childre
n o
f th
e p
ers
on
involv
ed.
– v
aries.
In F
landers
FC
at
hom
e m
ay b
e m
ore
expensiv
e to F
C than
resid
ential care
.
Difficultie
s in fin
din
g
cert
ifie
d n
urs
es. G
ovt.
am
eliora
ting w
ages
and w
ork
ing c
ondi-
tions.
Good q
ualit
y.
89
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Bulg
aria
135 long term
care
facili
ties c
overing 1
1
078 O
P.
Resid
en
tial care
– H
om
es for
eld
erly
people
accom
modate
those u
nable
to look
after
them
selv
es a
nd s
atisf
y their b
asic
needs; pers
ons w
ho a
re c
ert
ifie
d w
ith first
or
second d
egre
e o
f dis
abili
ty a
nd a
ctive
treatm
ent in
their c
ase h
as e
nded; per-
sons w
ho h
ave n
o r
ela
tives to take c
are
of
them
; pers
ons w
ho h
ave n
ot sig
ned a
contr
act fo
r cedin
g p
ropert
y a
gain
st obli-
gation for financia
l support
and / o
r care
.
Resp
ite
Sh
elt
ere
d h
ou
sin
g –
NO
Ho
sp
ital sta
y
Reh
ab
ilit
ati
on
Ho
sp
ice –
pallia
tive c
are
– N
O
Dem
en
tia
Paid
for fr
om
sta
te
and O
P p
ensio
n.
A c
ontr
act m
ay b
e
sig
ned f
or
cedin
g
pro
pert
y a
gain
st obli-
gation f
or financia
l
support
and / o
r care
.
No
Yes
?
Czech R
e-
public
74 4
99 b
eds in tota
l in
clu
din
g 5
4 2
61 b
eds
for
adults.
Resid
en
tial – L
ong w
aitin
g lis
ts, N
o long-
term
nurs
ing c
are
institu
tions. A
quite h
igh
pre
fere
nce a
mongst O
P for
resid
ential
care
. 67%
of 60 y
ears
consid
er
institu
tions
to b
e a
better
solu
tion a
nd a
better
guar-
ante
e o
f care
than liv
ing a
t hom
e o
r in
a
sheltere
d h
om
e w
ith h
om
e h
elp
. C
rite
ria
for
adm
issio
n to h
om
e o
r a b
oard
ing h
om
e
for
pensio
ners
are
: achie
vem
ent
of
the
retire
ment age a
nd s
ubm
issio
n o
f th
e
application for
pla
cem
ent,
Fre
e –
OP
continue to
receiv
e a
ll of pensio
n
+ a
ny d
ependence
allow
ance. E
ven for
long-t
erm
sta
ys o
f
more
than a
year,
covere
d b
y h
ealth
care
insura
nce.
Health insura
nce
com
panie
s t
ry to lim
it
the s
tay to 3
month
s
in their indiv
idual
contr
acts
with facili
-
Not financia
l – m
ay
even b
enefit fr
om
OP
pensio
n w
hen in r
esi-
dential health c
are
.
Can p
ay e
xtr
a for
better
facili
ties
FC
s t
ry to c
om
pen-
sate
for
poor
nutr
itio
n
and inadequate
nurs
-
ing.
FC
s u
sually s
upport
OP
in s
heltere
d u
nits.
Skill
ed n
urs
ing p
er-
sonnel consid
ere
d
unnecessary
in s
ocia
l
resid
ential in
stitu
tions
despite p
rovid
ing
serv
ices f
or
depend-
ent and s
ick o
lder
people
.
Directo
rs o
f re
sid
en-
tial hom
es d
o n
ot
need to m
eet any
qualif
ication c
rite
ria
Post
1989 N
GO
s
develo
ped m
any in-
novative types o
f care
and s
erv
ices a
nd
have fill
ed in m
any
gaps. R
esid
ential
hom
es o
rigin
ally
ow
ned b
y the s
tate
get re
gula
r fu
ndin
g
from
the s
tate
budget,
NG
Os h
ave to r
ais
e
their o
wn funds a
nd
they h
ave to a
pply
for
90
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Resp
ite –
Res. C
are
used for
tem
pora
ry-
respite c
are
, but lim
ited p
laces a
nd long
waitin
g lis
ts f
or
pla
cem
ent especia
lly in
Pra
gue a
nd o
ther
citie
s
Sh
elt
ere
d h
ou
sin
g in s
malle
r units in
com
munity
Hospital sta
y lim
it the d
ura
tion o
f a p
a-
tient’s s
tay in a
cute
depart
ments
and O
P
often n
ot w
elc
om
e.
Reh
ab
ilit
ati
on
– n
o
Ho
sp
ice –
pallia
tive c
are
– 6
hospic
es
with 1
71 b
eds r
un b
y N
GO
s, new
Dem
en
tia –
yes, new
ties b
ut fa
mili
es n
ot
able
or
will
ing to take
care
of
the O
P b
y-
pass this
3 m
onth
s
limit b
y m
ovin
g their
OP
fro
m o
ne facili
ty t
o
anoth
er
(and fro
m
one insura
nce c
om
-
pany to a
noth
er)
.
For
OP
in s
tandard
old
larg
e f
acili
ties,
they a
re o
ften r
em
ote
and F
C c
an’t g
et to
them
a g
rant fr
om
the s
tate
budget. G
rants
are
dis
trib
ute
d thro
ugh
the p
rocess o
f public
com
petition c
ontr
olle
d
by M
inis
try o
f Labour
and S
ocia
l A
ffairs
(and b
y M
inis
try o
f
Health).
Applic
ations
have to b
e s
ubm
itte
d
each y
ear
Denm
ark
Resid
en
tial – D
eclin
e in n
urs
ing h
om
e
beds f
rom
31,0
00 in 1
999 to 2
4,0
00 in
2003. 1987 e
nded c
onstr
uction o
f re
sid
en-
tial nurs
ing h
om
es a
nd e
ncoura
ged d
e-
velo
pm
ent of in
dependent specia
lised
housin
g f
or
OP
with c
are
serv
ices b
ein
g
pro
vid
ed in the h
om
e. “L
ost”
nurs
ing h
om
e
pla
ces r
epla
ced b
y independent housin
g
units for
old
er
people
– their n
um
ber
has
incre
ased f
rom
32,0
00 in 1
999 (
had b
een
18,0
00 in 1
994)
to a
lmost 43,0
00 in 2
003.
All
but 65 n
urs
ing h
om
e p
laces o
ut of
alm
ost 26,0
00 h
ave the h
ighest le
vel of
pro
vis
ion.
Resp
ite
Sh
elt
ere
d h
ou
sin
g –
Sheltere
d h
ousin
g
units h
as a
lso d
eclined– fro
m 4
640 in
1999to
3572 in 2
003.
Rent accom
modation. G
ood / Innovative
pra
ctice -
auth
orities
are
obliged to e
sta
b-
lish a
rela
tives’ coun-
cil
– the a
im is to
impro
ve d
ialo
gue a
nd
involv
em
ent
of
rela
-
tives o
f re
sid
ents
Yes
Yes A
ccounta
bili
ty
with r
egard
to the
quality
of care
is w
ith
LA
even w
hen r
ecip
i-
ents
of care
may
choose a
pro
vid
er
oth
er
than the p
ublic
pro
vid
er.
In a
dditio
n, a fra
me-
work
of
mechanis
ms,
whic
h a
llow
the r
e-
cip
ient (o
r re
latives)
to
com
pla
in a
nd a
ppeal,
is in p
lace.
91
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Un
its f
or
OP
incre
ased 8
8,0
00 in 1
999 to
91,0
00 in 2
003. 48,0
00 o
f th
is tota
l are
linked to e
xte
nsiv
e c
are
serv
ices.
Ho
sp
ital sta
y / R
eh
ab
ilit
ati
on
Ho
sp
ice –
pallia
tive c
are
Dem
en
tia –
In 2
002, th
ere
were
alm
ost
5000 p
laces d
esig
nate
d s
pecific
ally
for
pers
ons s
uff
ering fro
m d
em
entia –
incre
asin
g s
teadily
Fin
land
Resid
en
tial – In 2
001 3
.7%
of pers
ons
aged 6
5+
and 8
% a
ged 7
5+
were
liv
ing in
old
age h
om
es o
r housin
g w
ith 2
4 h
ours
assis
tance. 529 m
ill €
on inst care
. 89%
arr
anged b
y m
unic
ipalit
ies, 11%
by o
r-
ganiz
ations, and less than 1
% b
y s
mall
ente
rprises.
Resp
ite –
acute
, short
-term
or
inte
rval.
Care
in institu
tions
Sheltere
d h
ousin
g=
-Serv
ice h
ousin
g
Ho
sp
ital sta
y –
the n
um
ber
of clients
aged 6
5+
is d
ecre
asin
g in a
ll in
stitu
tional
care
in h
ealth c
are
.
Reh
ab
ilit
ati
on
- y
es
Ho
sp
ice –
pallia
tive c
are
- yes, som
e r
un
by p
rivate
foundations, m
ost in
health
centr
e h
ospitals
. – o
r at hom
e.
Dem
en
tia–-
in 1
995 (
late
st data
) fr
om
100
000 d
em
ente
d p
ers
ons 4
0 0
00 w
ere
in
long term
resid
ential care
.
Serv
ice h
ousin
g 2
4 h
r
assis
tance –
37 e
daily b
ed c
harg
e
Resid
ential hom
e –
96,9
e, In
patient pri-
mary
HC
– 1
35,9
e.
Need f
or
institu
tional
care
declin
ed b
e-
cause o
f in
cre
ase in
functional capacity o
f
65+
Depends o
n c
lient’s
financia
l sta
ndin
g a
nd
may n
ot exceed 8
0%
net in
com
e m
onth
ly.
(must have a
t le
ast 80
e for
ow
n e
xpenses)
Spouse s
ituation a
lso
taken into
account fo
r
LT
C
Good / Innovative
pra
ctice Y
es P
rofe
s-
sio
nal cert
ific
ation
defined b
y legis
lation
– o
nly
qualif
ied w
ork
-
ers
can g
et a job.
Hig
h level of
geriatr
ic
know
ledge a
mong
pro
fessio
nals
.
Min
istr
y o
f socia
l A
f-
fairs a
nd H
ealth g
ives
national re
com
men-
dations for
the d
ev.
and q
uality
of ser-
vic
es f
or
OP
– H
C,
serv
ice h
ousin
g a
nd
resid
ential care
. A
ct
as g
uid
elines for
Mu-
nic
ipalit
ies to e
valu
ate
the s
erv
ices they
offer.
Associa
tion o
f
Fin
. L a
nd R
eg A
uth
has a
lso tried to im
-
pro
ve Q
ualit
y o
f care
– b
ut each c
hooses
ow
n m
eth
ods.
Good / Innovative
pra
ctice -
Com
mon
repeat use o
f ques-
tionnaire o
n c
lient’s
opin
ions o
n a
vaila
bil-
ity, adequacy a
nd
92
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
functionalit
y o
f ser-
vic
es i.e
. user
feed-
back.
Fra
nce
Resid
en
tial – 4
71,0
00 p
ers
ons >
60
years
; m
ost
sta
te, som
e p
rivate
. 6.5
00
traditio
nal hom
es for
OP
(public, private
non p
rofit and c
om
merc
ial): av. no. of
pla
ces (
1996):
60 in p
rivate
non p
rofit
institu
tions, 75 in p
ublic
hom
es, 86 in p
ub-
lic h
om
es in p
ublic
hospitals
, 48 in p
rivate
com
merc
ial hom
es.
Popula
tion m
ain
ly f
em
ale
(w
idow
s,
62%
,
29%
sin
gle
s a
nd d
ivorc
ed).
Pop. old
due
to the a
v. age w
hen e
nte
ring: end o
f 1999,
79 y
ears
for
men, and 8
4 y
ears
for
wom
en.
Resp
ite. S
om
e institu
tions s
pecia
lize in
short
term
care
and v
ery
help
ful to
FC
s.
Sh
elt
ere
d h
ou
sin
g –
3.0
00 b
eds
Ho
sp
ital sta
y 1
,100 n
urs
ing h
om
es, gen-
era
lly d
ependin
g o
n a
public
hospital;
Reh
ab
ilit
ati
on
Ho
sp
ice -
pallia
tive c
are
Dem
en
tia 1
975, specia
l in
stitu
tion d
evel-
oped f
or
OP
suff
ering fro
m d
em
entia: th
e
“Canto
u”.
Tw
elv
e p
ers
ons a
re liv
ing to-
geth
er;
Costs
part
ly b
orn
by
resid
ents
and r
egio
nal
govern
ments
(C
on-
seils
généra
ux
Enorm
ous d
iffe
rences
from
one d
épart
em
ent
to the o
ther;
costs
: estim
ate
d a
t 3.9
bill
ion in 2
003 a
nd 4
bill
ion in 2
004.
The a
vera
ge m
onth
ly
rate
is 1
,300 €
(2004),
the a
vera
ge incom
e
of pensio
ners
1,4
40 /
month
for
men a
nd
894 /
month
for
wom
en
No –
institu
tions r
un
like h
ospitals
. F
C
limited to v
isitin
g –
often r
elu
cta
ntly.
Socia
l in
tegra
tion
extr
a m
uro
s is p
as-
siv
e. 70%
report
regu-
lar
fam
ily c
onta
ct and
vis
its f
rom
friends,
form
er
neig
hbours
and c
olleagues.
Am
ongst th
ose (
30%
)
who d
o n
ot have a
ny
conta
ct w
ith their
fam
ily tw
o in thre
e
decla
re that th
ey d
o
not have c
hild
ren o
r
that
all
fam
ily m
em
-
bers
are
dead
But in
CA
NT
OU
fam
-
ily m
em
bers
are
in-
vited to s
pend a
s
much tim
e a
s p
ossi-
ble
within
the g
roup,
part
icip
ating in a
nd
genera
ting a
ll sort
s o
f
indoor
and o
utd
oor
activitie
s.
Tra
inin
g a
vaila
ble
- but
no a
dvanta
ge in m
any
conte
xts
.
New
law
to u
p d
ate
and im
pro
ve the
30,0
00 m
edic
o-s
ocia
l
institu
tions for
old
and
dis
able
d p
ers
ons
(resid
ential and d
om
i-
cili
ary
serv
ices),
in-
clu
des the o
blig
ation
of qualit
y e
valu
ation.
But sin
ce the n
ew
govern
ment, “
Raff
arin
III”
, (M
arc
h 2
004),
this
inte
ntion s
eem
s to
have lost its p
riority
.
Very
negative im
ages
as o
ld h
ospic
es f
or
indig
ent / pro
ble
matic
and w
ere
huge. R
eal-
ity is b
etter
but im
age
sto
ps F
Cs w
anting to
use r
esid
ential
hom
es. 15%
of re
si-
dential in
sts
need
tota
l re
sto
ration, 30%
part
ly, i.e. 200,0
00
beds,
1 /
3 o
f to
tal;
93
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Germ
any
Resid
en
tial – G
row
th in n
os. +
suff
ering
from
dem
entia. In
1999 8
,659 L
TC
=
645,4
56 p
laces. >
half (
56,6
%)
financed
by independent charita
ble
org
anis
ations,
1 / 3
by p
rivate
com
merc
ial bodie
s
(34,9
%)
and the r
est public
(8,5
%).
28%
(554,0
00)
of people
in n
eed o
f care
are
in r
esid
ential care
. O
lder
genera
lly
than those c
are
d for
in d
om
estic s
ettin
g.
66%
in r
esid
ential care
are
80 y
ears
+ b
ut
only
44%
of care
d for in
dom
estic s
ettin
g
are
> 8
0
Resp
ite –
som
e a
vaila
ble
and p
aid
for
by
LT
CI but urb
an / r
ura
l diffe
rences.
Sh
elt
ere
d h
ou
sin
g –
many k
inds
Ho
sp
ital sta
y –
incre
ase in g
eriatr
ic in
patient fa
cili
ties t
hough long term
tre
nd is
to r
educe length
of
sta
y to r
educe c
osts
.
Reh
ab
ilit
ati
on
– y
es
Ho
sp
ice -
pallia
tive c
are
– y
es in a
ll
form
s
Dem
en
tia In 2
002, th
ere
were
alm
ost
5000 p
laces d
esig
nate
d f
or
pers
ons s
uf-
fering fro
m d
em
entia –
incre
asin
g s
teadily
LT
C insura
nce c
an b
e
used to p
ay tow
ard
s
care
costs
.
Care
allow
ances c
al-
cula
ted a
ccord
ing to
the c
are
cate
gories
whic
h p
ay f
or
medic
al
treatm
ent care
and
socia
l care
. O
ther
costs
paid
for
by the
pers
on in n
eed o
f
care
, w
ith p
ensio
n
and s
avin
gs o
r by
revert
ing to the r
e-
sourc
es o
f clo
se f
am
-
ily m
em
bers
. If O
P o
r
rela
tives h
ave n
o
resourc
es the s
ocia
l
welfare
pays in a
c-
cord
ance w
ith the
Federa
l Law
on W
el-
fare
Benefits
"support
in d
ifficult life-
situations".
In 1
998
36%
of all
resid
ents
of
old
people
s h
om
es
were
dependent on
socia
l w
elfare
.
All
pay s
om
e c
ontr
i-
bution to H
and S
C.
No-
FC
s s
een a
s
dis
ruptive-
not con-
sulted in h
ospital
care
, ju
st
pro
vid
e
cle
an laundry
, conta
ct
and s
upport
,
At le
ast
50%
of
the
nurs
ing c
are
sta
ff
em
plo
yed in r
esid
en-
tial in
stitu
tions m
ust
have a
pro
fessio
nal
qualif
ication if
they
care
for
more
than 4
pers
ons in n
eed o
f
care
and if specia
l
care
inte
rventions a
re
necessary
Yes-
LT
CI th
ru’ re
gu-
lations f
or
pro
fes-
sio
nal serv
ice p
rovid
-
ers
that la
y d
ow
n the
conte
nt
of
serv
ices
offere
d, org
aniz
a-
tional m
odes a
nd the
required q
ualif
ications
for
care
rs / n
urs
es
no s
tandard
ized q
ual-
ity c
ontr
ol pro
cedure
s
for
sheltere
d h
ousin
g
and t the q
ualit
y v
ar-
ies g
reatly
Gre
ece
Resid
en
tial-
Estim
ate
less t
han 1
% o
f
65+
. N
GO
s, C
hurc
hes, F
oundations a
nd
private
hom
es –
but no a
dequate
bre
ak-
Min
. in
ille
gal,
cro
wded f
acili
ties
600 €
, av. 1000 –
If O
P h
as inadequate
incom
e, fa
mili
es p
ay.
When in h
ospital F
Cs
Tra
inin
g r
equirem
ents
for
head n
urs
es b
ut
not fo
r assis
tants
. N
o
Min
istr
y h
as a
n In-
specto
rate
but fo
cus
traditio
nally
on e
nvi-
94
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
dow
n o
f num
bers
in e
ach k
ind.
Exact nos. unknow
n s
ince m
any p
laces
not re
gis
tere
d. T
raditio
nally
had to b
e s
elf-
caring b
ut in
cre
asin
g n
um
bers
are
de-
pendent on e
ntr
y a
nd m
any n
ow
effec-
tively
nurs
ing h
om
es.
In a
non r
epre
sent stu
dy o
f th
ose w
ith a
FC
17%
of th
e m
en a
nd 2
9%
of th
e
wom
en b
ein
g c
are
d for
spent th
eir term
i-
nal phase in a
nurs
ing h
om
e o
r clin
ic
Pri
vate
clin
ics –
num
bers
no k
now
n.
Sh
elt
ere
d h
ou
sin
g –
no
Ho
sp
ital sta
y –
decre
asin
g length
of sta
y
for
OP
Reh
ab
ilit
ati
on
– 3
public
+ p
rivate
units.
Hig
h d
em
and, in
adequate
covera
ge, no
hom
e r
ehab s
erv
ice, although s
om
e in-
sura
nce c
over fo
r lim
ited p
hysio
thera
py a
t
hom
e.
Ho
sp
ice –
pallia
tive c
are
– for
cancer
patients
Dem
en
tia -
recent develo
pm
ent of re
spite
care
and F
C s
upport
by A
lzheim
er
gro
ups
1400 s
ingle
room
s,
best re
sid
ential
hom
es a
ppro
x 2
000 €
- cost depends o
n the
degre
e o
f depend-
ency.
IKA
pensio
ns
are
appro
xim
ate
ly
500 €
p.m
.. O
nly
in
exceptional cases w
ill
the Insura
nce F
unds
pay t
he f
ull
costs
.
Private
clinic
s –
In-
sura
nce f
unds w
ill pay
for m
any o
f costs
for
term
inally
ill
patients
,
have to o
ffer
pra
ctical
help
in n
urs
ing.
Sm
all
resid
ential
hom
es in local are
as,
inclu
din
g r
eligio
us
hom
es, als
o u
sed b
y
work
ing f
am
ily c
are
rs
when c
an’t a
ccom
-
modate
the O
P w
ith
them
- F
C w
ho a
re
pro
xim
ate
oft
en p
ro-
vid
e p
ers
onal care
,
food a
nd c
om
pany for
the O
P w
hen the
care
r is
not at w
ork
.
Most re
sid
ential
hom
es e
ncoura
ge the
active p
art
icip
ation o
f
fam
ily c
are
rs a
s it
both
eases the c
are
tasks f
or
the s
taff a
nd
impro
ves the w
ell-
bein
g o
f th
e o
lder
pers
on.
min
imum
num
bers
of
sta
ffin
g f
or
hom
es.
ronm
ent and s
pace
sta
ndard
s r
ath
er
than
quality
of care
.
Fam
ilies o
ften v
ery
concern
ed w
ith level
and q
uality
of care
.
Private
clinic
s r
egis
-
tere
d w
ith M
inis
try
and h
ave b
asic
levels
of m
edic
al and n
urs
-
ing s
taff, although for
very
inte
nsiv
e c
are
needs, it is o
ften s
till
necessary
to e
mplo
y
private
nurs
ing a
ssis
-
tants
as in s
tate
hos-
pitals
et e
Hungary
R
esid
en
tial 3.2
% o
ver
60. In
1993 2
8 7
42
pers
ons liv
ed in s
uch institu
tions, by 2
001
was 4
1%
hig
her)
. U
nm
et needs-.
In 2
000
11 7
67 p
ers
ons w
ere
on the w
aitin
g lis
t fo
r
pla
ces, and 5
3%
waitin
g >
a y
ear
Founda-
tions, churc
hes, private
busin
esses Insti-
tutions m
ay s
et oth
er
crite
ria, e.g
. age.
New
resid
ential hom
e, younger
old
er
per-
in r
ehabili
tation insti-
tutions the fee
charg
ed m
ay n
ot
exceed 8
0%
of in
-
com
e o
f th
e r
ecip
ient
of care
Private
or
NG
O insti-
tutions w
hic
h d
o n
ot
Not financia
l
In h
ospitals
FC
s h
ave
to h
elp
because o
f
nurs
ing s
hort
ages.
Costs
of
payin
g for
better
medic
ines,
toile
t needs, better
meals
.
Has b
egun
Qualit
ative d
evelo
p-
ment can a
lso b
e
observ
ed in the c
ase
of re
sid
ential hom
es,
especia
lly in the w
ake
of in
vestigations b
y
the o
mbudsm
an a
nd
as a
result o
f fu
rther
95
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
sons, built by foundations a
nd c
hurc
hes
are
of a h
igh s
tandard
(in
contr
ast to
room
s for
4-1
6 p
ers
ons in the s
tate
hom
e)
and p
rovid
e g
ood s
erv
ices. – W
ith m
ort
al-
ity r
ate
dro
ppin
g a
nd institu
tions’ “t
urn
over
speed”
reduced. C
onsequently they w
ere
forc
ed to r
ais
e the a
ge for
entr
y (
e.g
. to
70
or
75 y
ears
) and a
lso the s
um
to b
e p
aid
on e
ntr
y.
Resp
ite U
sed for
respite c
are
especia
lly
by u
rban O
P.
Sh
elt
ere
d h
ou
sin
g
Ho
sp
ital sta
y –
fre
quent early d
ischarg
e
because o
f hig
h c
osts
Reh
ab
ilit
ati
on
– s
om
e, in
adequate
Ho
sp
ice –
pallia
tive c
are
– y
es
Dem
en
tia
wis
h to r
eceiv
e the
sta
te p
er
capita fund-
ing a
re fre
e to s
et an
entr
y c
harg
e u
sually
am
ounting to s
evera
l
mill
ion H
UF
(or
the
transfe
r of an a
part
-
ment th
ey a
re a
ble
to
sell),
as w
ell
as a
month
ly f
ee f
or
the
care
.= 1
%
train
ing for
the s
taff,
but th
e s
tandard
of
care
depended to a
larg
e e
xte
nt on the
main
tain
ing b
ody, th
e
age o
f th
e institu
tion
and the a
ttitude o
f its
head.
Irela
nd
Resid
en
tial – L
td p
ublic
and m
ain
ly p
ri-
vate
6.1
96 b
eds in p
rivate
and v
olu
nta
ry
hom
es w
ith p
ublic
fin
ance s
upport
+ 1
,281
contr
act beds w
ith c
ontr
act of health
board
with p
rivate
secto
r as p
rivate
care
.
Plu
s 3
85 furt
her
beds. 80%
of all
beds g
et
public f
undin
g.
4775 b
eds in p
rivate
and v
olu
nta
ry h
om
es
90-9
5%
occupancy r
ate
s. M
aj over
75,
only
16%
aged 6
5-7
5
Sh
elt
ere
d h
ou
sin
g -
yes
Ho
sp
ital sta
y
Means teste
d, client
or
fam
ily m
ay p
ay
costs
Nurs
ing h
om
e
care
is m
eans teste
d.
Tax r
elief allow
ed to
clie
nt or fa
mily
.
Som
e s
uperv
isio
n.
Lia
ison w
ith c
are
sta
ff.
The m
ajo
rity
of em
-
plo
yed s
taff
are
pro
-
fessio
nally q
ualif
ied.
Specia
list tr
ain
ing is
available
for
palli
ative
care
and d
em
entia
care
. T
rain
ing in n
urs
-
ing s
taff a
nd c
are
sta
ff
is c
om
puls
ory
There
is n
o n
ational
nurs
ing h
om
e inspec-
tora
te a
t th
e m
om
ent,
although p
lans for
a
nurs
ing h
om
e inspec-
tora
te a
re b
ein
g m
ade
and legis
lation is b
e-
ing d
raft
ed (
2005).
Private
nurs
ing
hom
es m
ust be r
egis
-
tere
d w
ith the H
SE
and a
re r
equired to
meet cert
ain
sta
n-
dard
s. H
ow
ever,
in-
96
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Reh
ab
ilit
ati
on
- y
es
Ho
sp
ice -
pallia
tive c
are
– y
es 6
centr
es,
7 s
pecia
lists
+ s
pecia
list palli
ative c
are
team
s a
nd s
upport
ed b
y N
GO
s
Dem
en
tia is u
nder
the r
em
it o
f P
sychia
try
of O
ld A
ge s
erv
ices p
rovid
ed b
y the
Health S
erv
ice E
xecutive. P
rovid
ed o
n in-
and o
ut patient basis
in n
on-a
cute
hospi-
tals
. P
sychia
try o
f O
ld A
ge s
erv
ices a
lso
available
in the c
om
munity, although s
uf-
fers
fro
m s
taff s
hort
ages. V
olu
nta
ry o
r-
ganis
ations a
lso p
rovid
e d
em
entia s
er-
vic
es s
uch a
s d
ay c
are
, hom
e c
are
, and
respite c
are
.
spection s
taff a
re
over-
str
etc
hed a
nd
under-
funded a
nd
care
sta
ndard
s c
an
vary
. T
he Irish H
os-
pic
e F
oundation h
as
published s
tandard
s
for
palli
ative a
nd b
e-
reavem
ent care
.
Italy
R
esid
en
tial 2%
of 65+ in h
om
es. B
ed
vacancie
s in n
urs
ing h
om
es, ra
ngin
g fro
m
34 p
er
1000 inhabitants
in the N
ort
h, to
13
in C
entr
al Italy
, and d
ow
n to 1
0 in the
South
. O
f all
OP
care
d f
or
in r
esid
ential
sett
ings,
73%
liv
e in the N
ort
h, 15%
in
Centr
al Italy
and 1
2%
in the S
outh
38%
of
resid
ential fa
cili
ties f
or
OP
are
public, 58%
are
private
and the r
em
ain
ing
4%
are
mix
ed s
tructu
res, w
ith r
ele
vant
diffe
rences b
etw
een s
ocia
l–assis
tance
and h
ealth-c
are
str
uctu
res, w
here
not fo
r -
pro
fit in
stitu
tions h
ave a
42%
and 2
5.8
%
pre
sence,
respectively
OP
more
depend-
ent in
all
institu
tions.
Resp
ite –
som
e
Sh
elt
ere
d h
ou
sin
g –
socia
l housin
g
gra
dually b
ecom
es m
ore
used b
y h
igher
The f
am
ily c
osts
for
private
care
at hom
e
are
often low
er
than
the r
esid
ential fe
es
Only
5%
of eld
erly
people
who m
ake u
se
of serv
ices o
ffere
d b
y
resid
ential care
do n
ot
pay a
nyth
ing, w
hilst
expenses f
or
62%
of
resid
ents
fall
entire
ly
upon the fam
ily,
where
as in 3
3%
of
cases h
ealth c
are
costs
are
part
ially
covere
d b
y the N
a-
tional H
ealth S
yste
m
fund.
Fam
ilies o
f 35-4
0%
of
the r
esid
ents
pro
bably
contr
ibute
equiv
ale
nt
to 2
50-5
00 €
p.m
..
Especia
lly in S
. Italy
and f
or
severe
ly a
f-
fecte
d O
P r
ela
tives
often r
equired b
oth
in
hospitals
and in m
any
resid
ential hom
es to
pro
vid
e n
ight assis
-
tance a
nd p
ers
onal
care
.
FC
support
may b
e
the c
onditio
n s
ine q
ua
non f
or
a O
P’s
adm
is-
sio
n to the c
aring
facili
ty b
ut has p
osi-
tive a
spects
to e
nsure
Yes –
but th
ough in
law
difficultie
s in g
et-
ting a
ll sta
ff tra
ined
because o
f short
ages.
Resid
ential hom
es
desig
ned f
or
self-
suffic
ient eld
erly p
eo-
ple
are
im
pro
perly
transfo
rmed into
long
care
hospital centr
es
97
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
dependent.
Ho
sp
ital sta
y –
1 / 3
of
beds for
severe
ly
ill p
eople
occupie
d b
y >
65 p
atients
Av.
period o
f sta
y is s
hort
er
in p
ublic
V p
rivate
str
uctu
res =
27 d
ays V
91 d
ays.
Reh
ab
ilit
ati
on
– y
es
Ho
sp
ice –
pallia
tive c
are
Dem
en
tia N
GO
led p
roje
ct in
itia
tives
non a
bandonm
ent
Luxem
bourg
Resid
en
tial -
4328 b
eds in 3
5 inte
gra
ted
cente
rs a
nd 1
4 n
urs
ing h
om
es. i.e. 63,1
40
aged 6
5+
- = 6
.8%
- (
hig
her
than
neig
hbouring c
ountr
ies w
hic
h h
ave 4
%)
One o
f hig
hest le
vels
of
availabili
ty in E
U.
Expandin
g b
y 1
350 u
nits.
Resp
ite –
yes
Sh
elt
ere
d h
ou
sin
g –
esp. fo
r m
enta
l
dis
able
d h
ave s
tart
ed Inte
gra
ted C
entr
e
for
Old
er
People
with D
isabili
ties o
pened,
with c
apacity for
56 s
enio
r re
sid
ents
,
managed b
y the “
Fondation K
raiz
bie
rg”.
Ho
sp
ital sta
y
Reh
ab
ilit
ati
on
- y
es
Ho
sp
ice-
pallia
tive c
are
yes, availa
ble
and s
pecia
l tr
ain
ing c
ours
es f
or
sta
ff in
palli
ative c
are
availa
ble
fro
m M
in. of
Health.
Dem
en
tia
35.8
2. € p
er
hour
vers
us 4
8 €
for
hom
e
care
Hig
h incom
es m
ean
most people
can a
f-
ford
it. A
nd N
at F
und
of S
olid
arity
pays a
ny
additio
nal costs
if
som
eone c
an’t a
fford
full
costs
. (7
00 b
ene-
ficia
ries)
But adequate
ly
funded a
nd s
taff w
ell
paid
No. F
undin
g is to O
P
thro
ugh the N
ational
Solid
arity
Fund
More
than h
alf a
re
fore
ign w
ork
ers
(main
ly E
U) in
the
care
and s
ocia
l sec-
tor.
Yes –
if
not already
qualif
ied, pro
fessio
nal
train
ing f
or
assis
tant
nurs
es a
vaila
ble
.
Specia
l cours
es in
palli
ative c
are
avail-
able
fro
m M
in. of
Health. E
ach e
m-
plo
yer
in the s
ocia
l
secto
r has to g
uara
n-
tee 2
0 h
ours
of
ad-
vanced tra
inin
g –
thus
continuous tra
inin
g is
com
puls
ory
Yes –
A Q
ualit
y m
an-
agem
ent syste
m b
e-
ing d
evelo
ped.
Malta
Resid
en
tial >
5%
of O
P 6
5+
liv
e in g
ov-
ern
ment and p
rivate
run h
om
es, but de-
mand incre
asin
g.
Private
rate
s a
re
hig
her
than those in
Sta
te o
wned o
r
Good c
are
but F
Cs
import
ant in
pro
vid
ing
psycholo
gic
al sup-
The m
ajo
rity
of em
-
plo
yed s
taff
are
pro
-
fessio
nally q
ualif
ied.
Main
ly s
tandard
s o
f
accom
modation,
cle
anlin
ess e
tc.
98
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Private
hom
es (
10)
2 o
f th
e 7
Sta
te-o
wned r
esid
ential hom
es
adm
inis
tere
d p
rivate
ly. 18 C
hurc
h-r
un
resid
ential hom
es p
rovid
ing a
round 6
00
beds.
Assessm
ent R
ehabili
tation T
eam
(AR
Team
) decid
es o
n e
ligib
ility
and p
rior-
ity o
f cases. T
o e
nte
r one o
f th
ese h
om
es,
an e
lderly p
ers
on m
ust be fully
mobile
and
capable
of liv
ing independently. W
ith o
ne
exception, th
ese h
om
es d
o n
ot have a
nurs
ing w
ing. A
dependent O
P g
oes to
a p
lace w
here
nurs
ing f
acili
ties a
re a
vail-
able
, such a
s S
VP
R o
r one o
f th
e p
rivate
hom
es.
Resp
ite R
esl. H
om
es u
sed a
lso f
or
Res-
pite c
are
.
Sh
elt
ere
d h
ou
sin
g
Ho
sp
ital sta
y
Reh
ab
ilit
ati
on
– Y
es
Ho
sp
ice –
palli
ative c
are
Dem
en
tia
Churc
h r
un r
esid
ential
hom
es d
ependin
g o
n
levels
of ‘h
ote
l’ ac-
com
modation a
nd
nurs
ing s
erv
ices r
e-
quired. C
osts
18 to
46 €
daily
.
In the larg
est sta
te
institu
tion w
ith m
ore
than 1
000 b
eds r
esi-
dent
pays 8
0%
of
his
tota
l in
com
e b
ut m
ust
still
have 1
380 €
p.a
.
for
self. In
oth
er
hom
es the O
P p
ays
60%
of his
tota
l in
-
com
e,
with s
am
e
conditio
n. E
stim
ate
d
actu
al daily
cost per
resid
ent am
ounts
to €
48.3
0 –
subsid
ized b
y
Sta
te.
Less n
uns m
eans
hig
her
use o
f la
y p
ro-
fessio
nals
and a
s a
result c
osts
are
ris
ing
port
, acting a
s inte
r-
media
ries, pro
vid
ers
of in
form
ation,
Als
o m
undane c
aring
tasks f
or
the O
P e
.g.
as w
ashin
g their
clo
thes, pers
onal
care
, cookin
g
meals
, housekeepin
g,
accom
panyin
g the
patient to
appoin
t-
ments
, and takin
g
specim
ens a
nd c
ol-
lecting r
esults.
The o
thers
, m
ain
ly
those o
ffering ‘hote
l
type’ serv
ices r
eceiv
e
in-h
ouse tra
inin
g
Neth
erlands
Resid
en
tial 5%
of O
P liv
e in r
esid
ential
hom
es, and a
bout 2,5
% in n
urs
ing h
om
es
Respite -
yes
Sh
elt
ere
d h
ou
sin
g
Ho
sp
ital sta
y 1
2%
aged 6
5-
74 a
dm
itte
d;
13%
75 +
V a
ge 5
5-6
4 (
7%
) and 3
5-
54
Incom
e r
ela
ted L
ow
co-p
aym
ent (m
ax.
€ 6
85.4
0 p
.m.)
, H
igh
co-p
aym
ent (m
ax.
€ 1
,700.-
p.m
.
1 in 1
0 F
C g
ive c
are
to p
eople
liv
ing in
health c
are
facili
ties
or
specia
l housin
g
facili
ties (
financia
l
affairs, gro
ceries,
transport
, w
ashin
g /
Resid
ential hom
es
have low
level of
train
ed s
taff
Nurs
ing h
om
es for
dependent have
train
ed s
taff
Larg
e s
erv
ice o
rgani-
zations h
ave o
wn
contr
ols
, but sm
all
org
aniz
ations d
o n
ot.
99
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
(5%
). 2
5%
75 y
ears
+ c
onta
cte
d a
medi-
cal specia
list
Reh
ab
ilit
ati
on
Res. H
om
es u
sed f
or
re-
habili
tation o
f both
eld
erly a
nd y
ounger
patients
, and in d
iagnosis
and functional
assessm
ent.
Ho
sp
ice -
pallia
tive c
are
– y
es a
vaila
ble
.
Dem
en
tia
bath
ing, (u
n-d
ressin
g,
feedin
g).
In h
olid
ay p
eriods
som
e n
urs
ing a
nd
resid
ential hom
es a
sk
for
extr
a h
elp
fro
m
FC
s b
ecause o
f per-
sonnel short
ages
Norw
ay
Resid
en
tial 9 / 1
0 o
lder
pare
nts
pre
fer
a
resid
ential settin
g if th
ey c
an n
o longer
live b
y them
selv
es. M
any u
nits a
nd s
hel-
tere
d h
ousin
g -
5.2
% o
f to
tal 67+
in s
hel-
tere
d h
ousin
g (
15.1
% b
y a
ge 9
0),
6.6
all
aged 6
7+
, by a
ge 9
0+
was 3
8.5
%. In
-
cre
ase in s
heltere
d h
ousin
g a
nd d
ecre
ase
in n
urs
ing h
om
es. S
hort
age o
f beds h
as
declined.
Adm
issio
n –
is d
egre
e o
f dependency.
Sh
elt
ere
d h
ou
sin
g 2
000 / 2
001, 80%
LA
s h
ad s
pecia
l units w
ith s
heltere
d liv
ing
for
pers
ons w
ith d
em
en
tia, (V
70%
1996)
LA
s w
ithout such u
nits a
re s
mall
(less
than 2
500 inhabitants
)
Resp
ite 5
5%
of LA
s h
ad s
pecia
l re
spite
arr
angem
ents
for
pers
ons w
ith d
em
en
tia.
Hospital sta
y –
earlie
r re
lease
Reh
ab
ilit
ati
on
– e
very
where
but a b
ed
short
age
Ho
sp
ice –
pallia
tive c
are
Go
od
/ In
no
vati
ve p
racti
ce -
2 L
As h
ave
Paym
ent re
late
s to
OP
incom
e =
75%
of
baseline o
f th
e N
a-
tional S
.I. € 6
,600,
supple
mente
d w
ith
maxim
um
85%
of
oth
er
form
s o
f in
com
e
(if any),
aft
er
taxes.
There
is a
basic
ex-
em
ption o
f € 7
30. O
n
avera
ge, users
pay
about one third o
f th
e
tota
l costs
for
nurs
ing
hom
e. Low
incom
e
resid
ents
pay less
Tota
l costs
vary
be-
tween m
unic
ipalit
ies.
(€ 5
4.9
00)
in 2
004.
Irre
spective o
f in
com
e
and c
osts
, every
resi-
dent is
guara
nte
ed a
min
imum
am
ount
at
ow
n, fr
ee d
isposal,
about € 2
50 p
.m.
Good / Innovative
pra
ctice -
FC
s f
ree t
o
develo
p their "
care
-
giv
er
care
ers
" in
the
institu
tional settin
g.
E.g
. spouses, vis
it
part
ners
as a
part
of
their d
aily
routines
giv
e p
ers
onal care
and a
ssis
t at m
eals
.
As a
n ideal, s
taff
and
FC
s h
ave initia
l and
follo
w-u
p m
eetings to
cla
rify
expecta
tions
and c
onsid
er
the in-
volv
em
ent of
the F
C.
In p
rincip
le, it is u
p to
the f
am
ily c
are
giv
er
to
decid
e h
ow
much
care
they w
ant to
giv
e
and the e
xte
nt to
whic
h they k
eep o
n to
the r
ela
tionship
.
Lack o
f tr
ain
ed n
urs
-
ing a
nd c
are
pers
on-
nel.
Action P
lan h
as f
o-
cused o
n m
odern
isin
g
nurs
ing h
om
es +
with
sin
gle
room
s for
all
OP
. LA
s r
esponsib
le
for
qualit
y a
nd s
tan-
dard
s o
f prim
ary
health a
nd s
ocia
l
serv
ices, re
gard
less
of w
ho c
arr
ies o
ut th
e
serv
ices, cpr.
super-
vis
ion legis
lation.
Contr
ol and s
uperv
i-
sio
n a
re s
hare
d b
e-
tween the o
ffic
es o
f
the C
ounty
govern
or
and the C
ounty
phy-
sic
ian
100
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
org
aniz
ed L
TC
in institu
tions b
uilt in
Spain
, as p
art
of th
eir r
egula
r old
age c
are
serv
ices
Pola
nd
Resid
en
tial – 7
8,9
35 p
eople
inclu
din
g
10.1
14 b
edridden; 23.6
% a
ged 6
1-7
4 a
nd
29.8
% a
ged 7
5 a
nd m
ore
. D
espite in-
cre
ase in p
laces m
ay w
aitin
g to b
e a
dm
it-
ted. 811 h
om
es 2
1.1
pla
ces p
er
10 thou-
sand p
eople
. T
his
has incre
ased b
y 3
.3
pla
ces s
ince 1
990. 18.6
to 2
3.9
per
10,0
00 p
eople
post-
pro
duction a
ge. V
.
uneven r
egio
nal dis
trib
ution though m
ore
eld
erly a
lso h
as m
ore
institu
tions. E
x m
u-
ral acti
vit
ies for
oth
er
OP
e.g
. m
eal,
thera
peutic a
ctivitie
s s
imila
r to
the d
ay
care
centr
es.
Resp
ite –
no
Sh
elt
ere
d h
ou
sin
g –
No s
heltere
d h
ous-
ing
Ho
sp
ital sta
y
Reh
ab
ilit
ati
on
Ho
sp
ice –
pallia
tive c
are
The c
ost
of
sta
y c
ov-
ere
d b
y the inhabi-
tant’s o
wn p
ensio
n
(3 / 4
of th
e p
ensio
n)
and b
y their fam
ilies,
but sin
ce this
rare
ly
covers
costs
main
ly
by s
ocia
l care
funds.
75%
hom
es fin
anced
by L
As a
nd m
anaged
by them
. O
ther
institu
-
tions a
re m
anaged b
y
churc
h a
nd N
GO
s.
Over
130 p
rivate
care
hom
es h
ave a
tota
l of
2300 p
laces-
these
vary
in p
rice a
nd a
re
more
expensiv
e. LA
s
adm
it b
ased o
n c
rite
-
ria (
medic
al plu
s loss
of fitn
ess (
need f
or
nurs
ing c
are
) or
de-
clin
e in s
ocia
l condi-
tions (
loneliness, la
ck
of fa
mily
, la
ck o
f abil-
ity to m
anage the
household
, very
low
incom
e e
tc.)
Yes t
o c
osts
if
they
can a
fford
it. –
Just
1%
.
FC
s d
o n
ot care
in the
institu
tion o
r in
a h
os-
pital – c
onflic
ts w
ith
pro
f. s
taff.
Yes
Varied b
ut im
pro
vin
g
sta
ndard
. P
rivate
ly
ow
ned h
om
es f
or
the
aged a
re n
ot under
superv
isio
n o
f socia
l
policy o
ffic
ers
(th
ere
are
docum
ente
d
cases o
f extr
em
e
negle
ct in
the p
ri-
vate
ly o
wned h
om
es).
Care
institu
tions o
r-
ganis
ed b
y N
GO
s a
re
usually s
uperv
ised b
y
local socia
l centr
es.
Port
ugal
Resid
en
tial 1,5
50 r
esid
ential hom
es a
nd
OP
hom
es w
ith 9
5.8
% u
tiliz
ation / 5
0,6
07
Main
ly p
rivate
, S
om
e
not fo
r pro
fit financed
Not active o
r part
ner-
ship
, but in
stitu
tion
No.
Heads o
f in
stitu
tions
Curr
ent tr
ansfo
rma-
tion into
inte
nsiv
e
101
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
65+
, m
ore
wom
en a
t all
ages. 3.3
% o
f
pop.
848 O
P H
om
es, 56 R
esid
ential hom
es.
28,8
02 o
n w
aitin
g lis
t in
1993
Sh
elt
ere
d h
ou
sin
g y
es, w
ith c
urr
ent
transfo
rmation o
f R
esid
ential H
om
es
Ho
sp
ital sta
y
Reh
ab
ilit
ati
on
very
few
serv
ices:1
7-2
7%
of aged o
ver
55, had a
ccess to r
ehabili
ta-
tion.
Ho
sp
ice –
pallia
tive c
are
Dem
en
tia –
no
by s
tate
.
Pre
f. for
sin
gle
eld
erly
with low
incom
e a
nd
without
FC
in O
ld
People
’s H
om
es
Private
OP
Hom
es
are
v.
expensiv
e.
ask F
C to p
art
icip
ate
in o
utings, fe
stivals
.
are
qualif
ied.
Encoura
gem
ent of
train
ing thru
pro
-
gra
mm
e o
f In
tegra
ted
support
for
the E
ld-
erly.
nurs
ing h
om
es o
r
sheltere
d h
ousin
g.
Gra
ndpare
nt P
lan
under
develo
pm
ent to
develo
p m
easure
s f
or
the c
ert
ific
ation o
f
institu
tional qualit
y.
Slo
venia
R
esid
en
tial 52 s
tate
hom
es.
4.3
% o
f O
P
= 1
2,0
00. O
P h
om
es
are
full
and long w
ait-
ing p
eriods.
1 / 4
of care
d-for people
at th
ese
hom
es
die
each y
ear. Incre
asi
ngly
pla
ces
with v
. dependent needin
g h
ealth
care
. A
v
capaci
ty a
round 2
00 b
eds;
low
est
60 b
eds;
av., room
s have 1
.97 b
eds
Som
e p
rivate
hom
es w
ith c
oncessio
n (
8)
resid
ences.
Resp
ite -
New
faci
litie
s are
hote
ls for th
e
eld
erly,
where
OP
live m
ost
ly tem
pora
rily
and
transi
tionally
. T
hey g
ive F
Cs
the c
hance to
take a
tem
pora
ry b
reak
since n
o p
roper re
s-
pite
care
. ‘T
em
pora
ry a
dm
issi
on’ o
nly
avail-
able
in 2
public
secto
r O
P h
om
es
and in
hosp
itals
.
Sh
elt
ere
d h
ou
sin
g –
new
– 3
00 u
nits in 9
pla
ces (
stu
dio
and o
ne-r
oom
apart
ments
,
som
e 2
-room
apart
ments
.) H
igh inte
rest
Private
- has t
o b
e
paid
for.
Entitlem
ent
OP
> 6
5 w
ith m
enta
l /
physic
al pro
ble
ms.
The n
um
ber
of re
cip
i-
ents
of th
ese s
erv
ices
depends o
n their
health c
onditio
ns.
Care
d-f
or
people
pay
for
serv
ices t
hem
-
selv
es if th
ey a
re
financia
lly c
apable
. 2 /
3 O
P in h
om
es e
n-
tire
ly c
overe
d t
he
costs
of
care
fro
m
ow
n r
esourc
es a
nd
with the h
elp
of
rela
-
tives (
out-
of-
payers
), 2
7.5
% o
f
Earlie
r re
lease f
rom
hospitals
– w
here
FC
do n
ot pla
y a
ny s
up-
port
ing p
art
– a
nd
absence o
f re
hab
facili
ties m
eans F
Cs
faced b
y p
roble
ms o
f
care
.
FC
s e
ncoura
ged to
work
with R
esid
ential.
hom
e –
and m
ore
hom
es w
ork
as tra
in-
ers
/ info
rmation for
FC
s o
f O
P in h
om
e
and in c
om
munity.
Yes, in
stitu
tional care
is p
rovid
ed b
y tra
ined
pers
onnel: s
ocia
l
work
ers
, tr
ain
ed
nurs
es, occupational
thera
pis
ts, physio
-
thera
pis
ts-
they h
ave
finis
hed s
pecia
lized
education / tra
inin
g.
How
ever
these insti-
tutions a
lso e
mplo
y
untr
ain
ed p
ers
onnel:
som
etim
es u
nem
-
plo
yed p
eople
are
offere
d w
ork
in institu
-
tions f
or
a lim
ited
period e
.g. a y
ear.
This
is a
pro
gra
mm
e
to r
educe u
nem
plo
y-
ment, tra
inin
g in c
are
Yes-
hom
es a
re o
f a
hig
h s
tandard
except
for
Hum
an a
spects
–
but th
ey a
re a
lso w
ell
contr
olle
d-
A lot of out
work
with thre
e-
mem
ber
contr
ol
com
mis
sio
ns, ap-
poin
ted b
y the M
inis
-
ter
from
the lis
t of
expert
s, perf
orm
regula
r and irr
egula
r
pro
fessio
nal and a
d-
min
istr
ative c
ontr
ols
.
The lis
t of 45 e
xpert
s,
who a
re a
dditio
nally
train
ed f
or
contr
ol
work
, is
pro
posed b
y
the S
ocia
l C
ham
ber
102
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
but in
realit
y they a
re o
ccupie
d r
ela
tively
slo
wly
because o
f hig
h p
rices, in
appro
pri-
ate
locations a
nd, above a
ll, the fact th
at
people
will not sell
their h
om
e in o
ld a
ge
and m
ove into
a s
malle
r apart
ment
Ho
sp
ital sta
y –
declin
ing
Reh
ab
ilit
ati
on
- inadequate
Ho
sp
ice –
pallia
tive c
are
Dem
en
tia
them
needed h
elp
in
the f
orm
of
a c
o-
paym
ent and o
nly
8%
of people
had the
costs
of
care
entire
ly
paid
. If O
P n
ot able
to
pay, adult c
hildre
n in
the first pla
ce o
r m
u-
nic
ipalit
ies in the s
ec-
ond p
lace a
re law
fully
obliged to h
elp
them
.
People
must
pay f
or
hote
l serv
ices fully
and their p
rices a
re
hig
her
than for
hom
es
of th
e p
ublic
netw
ork
.
Tem
p a
dm
issio
n –
prices p
aid
by O
P /
FC
available
but not
obligato
ry, and thus
not im
ple
mente
d e
ve-
ryw
here
. T
hey d
o
basic
hygie
ne c
are
.
of S
lovenia
.
103
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Spain
R
esid
en
tial T
he r
atio o
f re
sid
ential pla
ces
was 3
.4%
of th
e o
ver
65s, of w
hic
h 1
.26%
were
public-
larg
e incre
ase.
The r
atio o
f public
housin
g u
nder
care
was 0
.05%
of th
e o
ver
65s,. L
arg
e R
e-
gio
nal diffe
rences-
with C
ata
lonia
as
leader.
Liv
ing a
lone, re
gard
less o
f th
e
exis
tence o
f child
ren, and s
erious d
e-
pendency f
acili
tate
access
Sh
elt
ere
d h
ou
sin
g A
lso 4
,280 g
uard
ed
housin
g p
laces in the c
ountr
y d
istr
ibute
d
aro
und 3
96 h
ouses.
Resp
ite t
em
pora
ry s
tays w
as 0
.03%
in
1999, alm
ost entire
ly o
n the c
om
munity o
f
Madrid (
0.1
7%
) and in the B
asque C
oun-
try (
0.0
9%
)
Ho
sp
ital sta
y
Reh
ab
ilit
ati
on
Ho
sp
ice –
pallia
tive c
are
– e
ssentially
not availa
ble
.
Dem
en
tia -
no
Public
-.r
equires h
igh
dependency a
nd little
wealth
Private
- e
xclu
siv
ely
financia
l. 5
8.8
%
pla
ces fin
anced
wholly b
y the u
ser,
and the r
est th
is b
y
the p
ublic
secto
r. 7
0%
of th
e p
ublic
cost fo
r
LT
C is for
resid
ential
serv
ices. U
ser’s c
on-
trib
ution to t
he c
ost
of
the p
ublic
resid
ential
pla
ces lie
s a
t aro
und
75%
of th
eir p
ensio
n.
In 2
000, private
month
ly p
rice a
lmost
900 €
. B
ut diffe
rences
betw
een p
rofit-
makin
g
institu
tions (
som
e
1052 €
p.m
.) a
nd the
rest, n
orm
ally
reli-
gio
us, charg
ing
aro
und h
alf o
f th
e
oth
ers
. P
ublic
resi-
dences in 2
000 w
ere
702 €
. A
v. P
rice =
42%
of hig
hest aver-
age s
ala
ry a
nd 6
3%
of th
e low
est avera
ge
sala
ry
Yes in h
ospitals
- help
to m
ain
tain
hygie
ne,
mora
l support
and
genera
l superv
isio
n o
f
their n
eeds.
For
hig
her
level sta
ff it
exis
ts
Main
ly b
y R
egio
ns
usin
g a
dm
inis
trative
crite
ria -
str
uctu
ral
(location, in
tern
al
dis
trib
ution, fa
cili
ties,
serv
ices, etc
.) a
nd
functional (inte
rnal
regula
tions, prices,
fire
pre
vention, pro
-
gra
mm
ing).
Sw
eden
Resid
en
tial /
Sh
elt
ere
d h
ou
sin
g –
Under
3 types o
f cost: h
ous-
Not expecte
d though
50%
care
pers
onnel
Yes m
unic
ipalit
y a
nd
104
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
one “
um
bre
lla”
headin
g; “s
pecia
l housin
g”
with s
erv
ice a
nd c
are
for O
P c
om
prisin
g:
nurs
ing h
om
es, O
A h
om
es, serv
ice
houses, gro
up h
om
es U
ntil early ‘80s,
institu
tional care
expanded w
ith c
hanges
in p
opula
tion. B
ut sin
ce s
tagnate
d. In
2003, 110 9
00 p
ers
ons liv
ing in d
iffe
rent
form
s o
f in
stitu
tional care
or
in “
specia
l
housin
g”
for
OP
= s
erv
ice c
overa
ge o
f
7.2
% o
f 65 y
rs+
and 1
9%
am
ong those 8
0
yrs
+.
Just
13%
of
OP
in p
rivate
care
.
Ho
sp
ital sta
y -
Earlie
r dis
charg
es f
rom
hospital m
eans O
P a
re m
ore
fra
il w
hen
goin
g into
oth
er
form
s o
f sheltere
d h
ous-
ing o
r goin
g h
om
e.
Reh
ab
ilit
ati
on
– thru
’ P
HC
Ho
sp
ice –
pallia
tive c
are
– P
alli
ative
care
availa
ble
thro
ughout th
e c
ountr
y.
Dem
en
tia –
25 0
00 b
eds in g
roup h
om
es
ing, m
eals
, and c
are
.
Av. net-
incom
e
am
ong O
P is 8
500
SE
K p
.m.. T
he a
ver-
age c
ost fo
r housin
g
is e
stim
ate
d to 2
500
SE
K, fo
od / m
eals
to
2 4
00 S
EK
and c
ost
for
care
at 500 S
EK
p.m
.. O
n a
v. 5 4
00
SE
K c
are
p.m
. or
alm
ost tw
o thirds o
f
incom
e p
rocess o
f
needs a
ssessm
ent,
carr
ied o
ut by the
munic
ipal care
man-
ager.
Access c
rite
ria
may a
nd d
o v
ery
much d
iffe
r fr
om
one
munic
ipalit
y to a
n-
oth
er.
How
ever,
the
level of
dependency
and d
egre
e o
f cogni-
tive im
pairm
ent is
often d
ecis
ive.
Innovative a
spects
-
Adm
issio
n is n
ot
based o
n m
eans-
testing.
fam
ilies d
o p
art
ici-
pate
. In
recent years
there
is a
shift in
atti-
tudes a
nd c
are
per-
sonnel are
more
and
more
focusin
g o
n the
(form
er)
care
r, to
colla
bora
te a
nd c
re-
ate
“care
r- friendly
institu
tions.
has a
t pre
sent th
e
requeste
d tra
inin
g for
the w
ork
(upper
sec-
ondary
school-le
vel),
prim
arily
due to d
iffi-
cultie
s to r
ecru
it c
are
pers
onnel w
ith a
de-
quate
tra
inin
g a
nd
skill
s
national board
s. T
he
monitoring a
uth
orities
work
fro
m the r
e-
gio
nal le
vel.
Sw
itzerland
Resid
en
tial 1422 h
om
es, corr
espondin
g
to 7
6,0
24 T
wo thirds o
f th
e institu
tions a
re
financed b
y p
ublic
funds, one-t
hird b
y
private
foundations.
Inadequate
sta
ffin
g –
mig
rant w
ork
ers
re-
sort
ed
105
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Resp
ite –
yes –
in h
ospitals
and s
om
e
canto
ns h
ave h
oste
ls
Sh
elt
ere
d h
ou
sin
g –
no d
ata
Ho
sp
ital sta
y
Reh
ab
ilit
ati
on
Ho
sp
ice –
pallia
tive c
are
Dem
en
tia –
not in
institu
tions
UK
R
esid
en
tial-
Betw
een 2
000 a
nd 2
001 a
3%
decre
ase in r
esid
ential care
hom
es
and a
decre
ase o
f 3%
in n
urs
ing h
om
es
and p
rivate
hospitals
and c
linic
s. O
ver
half
(54%
) of
support
ed r
esid
ents
were
in in-
dependent re
sid
ential care
hom
es, 27%
were
in independent nurs
ing h
om
es a
nd
16%
were
in L
ocal auth
ority
sta
ffed
hom
es. M
aj over
85+
There
were
431,2
00 r
esid
ential pla
ces in
24,1
00 r
esid
ential care
hom
es a
nd
186,8
00 r
egis
tere
d b
eds in 5
,700 n
urs
ing
hom
es a
nd p
rivate
hospitals
and c
linic
s.
Resp
ite –
wid
espre
ad
Sh
elt
ere
d h
ou
sin
g-
3.5
% o
f people
aged
65 to 6
9 to 1
9%
aged 8
5
Hospital sta
y
Reh
ab
ilit
ati
on
– full
and s
pecia
lised s
er-
vic
es in h
ospitals
, day c
are
and h
om
e
care
team
s. D
anger
of ig
noring the m
ost
frail,
Ho
sp
ice –
pallia
tive c
are
– g
row
th,
NG
Os
Avera
ge c
ost fo
r pri-
vate
resid
ential care
was £
302 p
er
week
and the a
vera
ge c
ost
for
private
nurs
ing
care
was £
422 p
er
week –
OA
P is £
80
per
week. M
ajo
rity
of
the f
undin
g for
the
care
of
old
er
people
is
pro
vid
ed b
y the p
ublic
secto
r.
OP
assets
pay f
or
resid
ential costs
(only
£12000 p
ounds left)
If
indiv
iduals
have m
ore
than £
19,5
00 in c
api-
tal th
en they h
ave t
o
pay t
he f
ull
cost
of
resid
ential or
nurs
ing
hom
e c
are
.
No
In h
ouse tra
inin
g for
low
er
gra
de w
ork
ers
–
pro
fessio
nals
fully
qualif
ied. O
vera
ll lo
w
level of
train
ing f
or
care
work
ers
, w
ith
train
ing f
ocusin
g o
n
min
imal health a
nd
safe
ty r
equirem
ents
,
not philo
sophy o
f care
and the d
evelo
pm
ent
of in
terp
ers
onal skill
s.
New
requirem
ent fo
r
50%
of care
assis
-
tants
to h
ave N
VQ
Level 2 b
y 2
005, pro
-
vid
ing a
sig
nific
ant
challenge f
or
care
hom
es
Nurs
ing h
om
es a
nd
care
hom
es h
ave to
be inspecte
d a
min
i-
mum
of
twic
e a
year.
One inspection is
announced s
o the
hom
es a
re a
ware
when t
hey a
re c
om
-
ing, but one is u
nan-
nounced w
ork
ers
know
they a
re c
om
ing
but in
spection is that
the inspecto
rs turn
up
unannounced. T
he
Care
Sta
ndard
s A
ct
has n
ow
set national
sta
ndard
s s
o that
serv
ices s
hould
be
equiv
ale
nt in
diffe
rent
part
s o
f th
e c
ountr
y.
Inspection r
eport
s a
re
publicly
availa
ble
.
106
Co
un
try
% in
resid
en
tial care
(60+
, 65+
)
Availab
ilit
y
Co
sts
of
resid
en
tial
care
- A
ffo
rdab
ilit
y
Fam
ily c
are
co
ntr
i-
bu
tio
n
Tra
inin
g o
f w
ork
ers
Q
uality
an
d c
on
tro
l
of
resid
en
tial care
Dem
en
tia 1
.5 m
illio
n o
f people
over
85.?
107
5.8
A
nn
ex 8
– M
atr
ix o
f H
om
e B
as
ed
Serv
ices
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Austr
ia
Ho
me H
elp
an
d L
ocal co
ord
inati
on
cen
tres 5
% a
ged 6
5 +
get hom
e c
are
.
17%
am
ong c
are
dependent eld
erly –
gro
wth
slo
wed p
ost 1990s in n
os. of
clie
nts
and s
erv
ice h
ours
.
Few
private
serv
ices
Day C
are
cen
tres –
Yes,
gro
wth
.
Ho
me h
ealt
h c
are
-P
artia
l covera
ge
Dem
en
tia s
erv
ices –
yes a
nd g
row
ing*
- hig
h d
em
and. In
adequate
covera
ge.
Resp
ite c
are
at
ho
me -
in s
om
e r
e-
gio
ns
Serv
ices u
sed b
y 6
0%
of
pers
ons liv
ing
alo
ne a
nd 4
1%
of
pers
ons s
haring a
household
.
Larg
e r
egio
nal dis
parities
in o
rganiz
ational fo
rm,
quality
, develo
pm
ent and
co-o
rdin
ation o
f serv
ices.
HH
usually 2
x w
eek; in
critical cases 5
x w
eek o
r
daily. Low
er
Austr
ia 2
00+
Socia
l S
tations r
un b
y 4
NG
Os a
s o
ne-s
top-s
hops
offering s
erv
ices w
ith
hom
e n
urs
ing a
nd H
H
core
com
pete
ncie
s, +
som
e r
espite c
are
. N
GO
s
pro
vid
e 9
0%
of com
mu-
nity a
nd s
em
i-in
stitu
tional
care
serv
ices; re
imburs
ed
by t
he p
rovin
ce o
r LA
.
With intr
oduction o
f LT
C A
l-
low
ance a
bout 1 / 3
pers
ons
receiv
ing this
cash p
aym
ent
is a
ble
to u
se m
ore
com
mu-
nity s
erv
ices than b
efo
re
27%
of to
tal expenditure
s for
health a
nd s
ocia
l serv
ices is
covere
d b
y c
ontr
ibutions o
f
users
and their r
ela
tives
Inad
eq
uate
qu
ality
co
ntr
ol.
Contr
ol based o
n c
lients
or
fam
ily m
em
bers
’ com
pla
ints
,
periodic
hom
e v
isits, and tele
-
phone c
onta
ct w
ith b
eneficia
r-
ies.
"Str
uctu
ral qualit
y a
ssessm
ent"
used a
dm
inis
tratively
e.g
. cli-
ent / care
r ra
tio e
tc.
NG
Os h
ave inte
rnal qualit
y
assura
nce p
rogra
mm
es b
ut
unknow
n r
esults.
Tra
inin
g-
Adequate
- M
ost
train
ed R
egio
nal sta
ndard
s. N
o
nationw
ide r
egula
tions / s
tan-
dard
s f
or
hom
e &
fam
ily h
elp
-
ers
, geriatr
ic a
ides.
Belg
ium
Ho
me H
elp
an
d L
ocal co
ord
inati
on
cen
tres 4
.9%
of
people
65-7
4 a
nd
26.1
% o
f 75 y
ears
+ u
sed h
om
e h
elp
in
2001.
136 local serv
ice c
entr
es-
Fle
mis
h,
access to p
rofe
ssio
nal care
and info
r-
mation. 53 c
oord
ination c
entr
es in W
al-
loon a
rea. D
em
and e
xceedin
g p
rovi-
sio
n.
M
eans teste
d w
ith r
eductions
for
heavily
dependent. P
riority
to O
P w
ith h
igh d
ependency
and low
incom
e. C
osts
for
the
OP
rela
te to f
am
ily incom
e
Min
. € 0
.50 p
.h., m
ax. re
al
cost of help
i.e
. € 2
2.5
0 p
.h.
av. C
ontr
ibution €
3 p
er
hour,
30%
hig
her
if h
elp
needed 8
pm
-7 a
m o
r S
ats
.; 6
0%
hig
her
Ad
eq
uate
qu
ality
co
ntr
ol.
in
Fla
nders
must
have m
issio
n
sta
tem
ent.
Tra
inin
g-
Good.
All
train
ed
cert
ific
ate
s c
om
puls
ory
.
H &
SC
work
ers
bein
g tra
ined
to w
ork
with F
C
108
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Day C
are
cen
tres –
Yes,
gro
wth
. 0.3
%
of O
P 6
5-
74 y
ears
of
age a
nd 0
.7%
of
OP
75 y
ears
+ in 2
001
Ho
me h
ealt
h c
are
- C
om
pre
hensiv
e
covera
ge
Dem
en
tia s
erv
ices –
yes a
nd g
row
ing
Resp
ite c
are
10,0
00 h
ours
of sit-in
care
p.a
., a
t le
ast half p
rovid
ed b
y v
ol-
unte
ers
.
on S
undays a
nd p
ublic h
oli-
days. V
ery
dependent get
dis
counts
.
Bulg
aria
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres 2
62 F
C s
erv
ice o
ffic
es w
ith 3
5
172 p
laces.
Day C
are
cen
tres –
Yes, gro
wth
; pro
-
vid
e p
ossib
ility
for
day n
urs
ing inclu
din
g
OP
.
Ho
me h
ealt
h c
are
-P
artia
l covera
ge –
inte
gra
ted c
are
with S
S.
Dem
en
tia s
erv
ices –
yes in d
ay c
are
centr
es
Resp
ite c
are
- no though s
um
mer
cam
ps o
ffer
som
e r
elie
f.
Socia
l care
inclu
des b
u-
reaux for
socia
l serv
ices,
hom
es for
eld
erly p
eople
and c
lubs o
f th
e d
isable
d.
Soup k
itchens p
rovid
e
food for
indig
ent pers
ons
and f
am
ilies
Oft
en d
ifficult for
people
to
pay the fees. socia
l assis
-
tance b
enefits
do n
ot cover
costs
.
Inad
eq
uate
qu
ality
co
ntr
ol.
Serv
ice d
om
inate
d b
y q
uantita
-
tive indic
ato
rs
Tra
inin
g –
Good v
irtu
ally
all.
Czech R
epublic
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres a
ppro
x. 10%
uses d
om
icili
ary
serv
ices. 31%
of com
munitie
s c
overe
d
by H
H s
erv
ice-
107 0
00 c
lients
. 26%
lived in s
heltere
d h
ouses, 37%
got
meals
on w
heels
, 24%
vis
ited p
ers
onal
hygie
ne c
entr
es, 13%
used laundry
20%
of
60+
have s
erious
health p
roble
ms
Big
ger
LA
s, esta
blis
h
houses o
f nurs
ing c
are
.
1879 n
urs
es m
ostly o
r-
ganis
ed in p
rivate
or
not
for
pro
fit hom
e c
are
GP
s h
as a
budget perm
itting
hom
e c
are
but expensiv
e for
their b
udgets
and a
gencie
s
are
able
to p
rovid
e n
urs
ing
care
on w
eekends a
nd a
t
nig
hts
. A
nd thus less p
re-
scribed than h
ospital care
–
whic
h d
oes n
ot com
e o
ut of
Inad
eq
uate
qu
ality
co
ntr
ol –
som
e H
H s
erv
ice p
rovid
ers
have o
wn s
tandard
s o
f qualit
y.
Min
istr
y e
labora
ted r
ecom
men-
dations for
genera
l socia
l care
sta
ndard
s o
f qualit
y.
Tra
inin
g-
Inadequate
– m
any
109
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
serv
ices
Private
serv
ices a
lso a
vaila
ble
.
Day C
are
cen
tres –
Som
e d
ay a
nd
week c
entr
es -
0,6
% v
isited d
ay c
entr
es
for
OP
Larg
e d
em
and.
Ho
me h
ealt
h c
are
-P
artia
l covera
ge
Dem
en
tia s
erv
ices –
Yes –
som
e for
FC
s t
hru
’ A
lzheim
er
Associa
tions.
Resp
ite c
are
- A
lzheim
er
linked F
C
only
. O
ther
serv
ices n
ot availa
ble
in
hom
e.
agencie
s.
their b
udget
Gro
wth
in p
rivate
paym
ent fo
r
som
e H
S. e.g
. physio
thera
-
pis
ts
untr
ain
ed. N
o s
yste
m o
f cert
ifi-
cation. C
zech A
ssocia
tion o
f
Nurs
es intr
oduced the s
yste
m
of re
gis
tration a
nd c
ontinual
education o
f nurs
es b
ut not
com
puls
ory
Denm
ark
H
om
e H
elp
and L
ocal co
ord
inati
on
cen
tres 1
5%
60+
get H
H, O
f 700,0
00
67+
, 172,0
00 6
7+ h
ad L
T H
H, +
8-7
000
67+
receiv
e s
hort
-term
HH
. 50%
80+
get LT
HH
., 8
0%
for
pers
onal care
,
20%
pra
ctical help
in the h
om
e (
cle
an-
ing, shoppin
g a
nd laundry
)., 60%
to 8
0+
Gro
wth
of
private
serv
ices
Day C
are
cen
tres -
yes
Hom
e h
ealth c
are
- c
om
pre
hensiv
e
Dem
en
tia s
erv
ices –
incom
ple
te. D
a-
neA
ge r
un v
olu
nte
er-
based r
espite
serv
ice for
FC
s,
Resp
ite c
are
– L
A o
blig
ed u
nder
SS
Law
to p
rovid
e F
Cs c
aring f
/ t w
ith it.
50%
of re
cip
ients
get <
2
hours
per
week, av. hours
per
week is 4
.5 u
nder
80
and 6
.1 for
80+
. 13,0
00
recip
ients
67+
< 2
0 h
rs
p.w
. 1,0
80,0
00 h
ours
of
HH
weekly
100,0
00 p
ers
ons s
uff
er
from
dem
entia
Fre
e, th
ough m
any O
P feel
they s
hould
contr
ibute
to L
A.
Every
one e
ligib
le a
fter
a c
er-
tain
age.
12%
60+
buy in p
rivate
hom
e
help
serv
ices in the h
om
e
while a
n a
dditio
nal 3%
re-
ceiv
e b
oth
public
hom
e-h
elp
serv
ices a
nd
buy in p
rivate
serv
ices
Ad
eq
uate
qu
ality
co
ntr
ol –
Local govern
ment re
searc
h
institu
te (
AK
F)
carr
ies o
ut
evalu
ation a
nd m
onitoring o
f
serv
ices in L
As
Tra
inin
g –
Good, all
train
ed
DaneA
ge tra
ins v
olu
nte
ers
110
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Fin
land
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres 1
0.6
% a
ge 6
5+
get H
H-
4 / 5
from
LA
s,
rest fr
om
private
serv
ices.
Pers
onal care
and s
erv
ice p
lans m
ade
by m
ulti pro
f (H
+S
S)
team
s f
or
pers
ons
in c
ontinuous n
eed f
or
care
. In
cre
ased
focus o
n o
lder
OP
. S
light declin
e in
num
bers
receiv
ing H
H a
nd H
om
e n
urs
-
ing.
Day C
are
cen
tres -
yes p
ublic a
nd
private
incre
asin
g
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e
Dem
en
tia s
erv
ices -
Yes
Resp
ite c
are
– y
es-
NG
Os a
nd L
As –
pro
posed t
o b
e m
andato
ry in f
utu
re f
or
FC
s.
Palli
ative c
are
als
o a
t hom
e.
Hom
e c
are
and h
om
e
nurs
ing 2
x p
er
week.
80%
HH
fro
m L
As, 13%
from
NG
Os,
private
–
10%
Som
e s
erv
ices fre
e e
.g. re
-
hab,
HH
for
term
inally
ill,
nurs
ing c
are
at hom
e, la
b
tests
at hom
e. C
lient fe
es e
.g.
docto
r – 2
2 €
p.a
. m
ax. P
HC
em
erg
ency –
max 1
5 €
for
hom
e n
urs
ing-
dependin
g o
n
household
incom
e a
nd s
ize-
fee v
aries f
rom
11-3
5 €
Tax
reductions a
vaila
ble
for
pur-
chase o
f dom
estic w
ork
.
Som
e c
ontr
ibution f
or
costs
of
day c
are
. (s
om
e fre
e thru
’ LA
,
som
e p
rivate
/ N
GO
and p
aid
for)
Respite p
art
ly p
aid
for
by
FC
.
Go
od
qu
ality
co
ntr
ol
– G
ovt.
pro
vid
es n
ational re
com
menda-
tions-
and c
itiz
ens a
sked r
egu-
larly f
or
com
ments
by L
As.
Tra
inin
g-
Good a
ll tr
ain
ed.
Only
qualif
ied c
an g
et a job.
Have p
roje
ct to
pro
mote
work
abili
ty a
nd m
ain
tain
well b
ein
g
at w
ork
because o
f hig
h turn
over.
Fra
nce
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres –
Access to a
hom
e-h
elp
er
and
oth
er
dom
icili
ary
serv
ices (
nurs
ing e
x-
clu
ded)
is n
ot a legal right.
Day C
are
cen
tres –
som
e, m
ore
needed
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e
inclu
din
g h
ospitaliz
ation a
t hom
e,
para
medic
al serv
ice.
deliv
ery
of dru
gs,
Access is a
legal right.
Dem
en
tia s
erv
ices –
som
e; m
ore
Regio
ns v
ary
- M
ultitude
of private
and p
ublic
or-
ganiz
ations b
ased o
n
diffe
rent financia
l
sourc
es. R
egio
nal varia-
tions in r
ange o
f serv
ices:
oth
er
serv
ices inclu
de
accom
panyin
g, adapta
-
tion o
f th
e h
om
e, adm
inis
-
trative h
elp
, hom
e a
larm
,
keepin
g c
om
pany, m
eals
,
mobile lib
rary
, re
pairs,
shoppin
g, te
chnic
al help
,
Means teste
d f
or
child
ren o
f
OP
.
Nurs
ing a
nd o
ther
para
medi-
cal com
munity s
erv
ices a
re
financed b
y the N
.H.I; hig
her
incom
e r
ecip
ients
can b
e
asked f
or
co-f
inancin
g. H
.H is f
inanced
from
num
ero
us p
rivate
and
public s
ourc
es
Oth
er
serv
ices e
.g. house
ala
rm s
yste
ms o
r m
eals
on
Ad
eq
uate
qu
ality
co
ntr
ol
Regio
nal auth
ority
responsib
le
for m
anagem
ent / superv
isio
n
pro
vid
ed in the A
PA
pro
-
gra
mm
e. S
pecia
l com
pute
r
pro
gra
ms d
evelo
ped for
qualit
y
contr
ol (&
in r
esid
ential care
).
NG
Os e
labora
te w
ith s
taff
, in
di-
vid
ual qualit
y p
lans b
ased o
n
their d
efinitio
ns, aim
s, and e
x-
pecta
tions.
Tra
inin
g. In
adequate
– m
any
111
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
needed
Resp
ite c
are
– y
es a
nd a
lso inclu
des
gra
nny s
itting a
nd d
ay o
r nig
ht care
at
hom
e,
transport
ation, tu
tela
ge
wheels
oft
en fin
anced b
y the
regio
nal govern
ment w
ith c
o-
fundin
g f
rom
recip
ient.
untr
ain
ed L
ow
im
pact of new
care
dip
lom
a a
s u
nskill
ed H
H
sta
ff e
asily fin
d w
ork
& c
ert
ific
a-
tion h
as n
o im
pact on s
ala
ry.
Germ
any
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres 1
in 1
5 a
ged 7
5 +
get hom
e
care
. 18%
of household
s.
Day C
are
cen
tres –
Gro
wth
; availa
ble
if F
C c
annot be g
uara
nte
ed o
r if d
ay
care
is n
ecessary
to e
ase the b
urd
en
on f
am
ily c
are
rs.
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e
Dem
en
tia s
erv
ices -
som
e, in
adequate
and n
eed e
xpandin
g
Resp
ite c
are
- s
om
e
HH
by N
GO
s a
nd p
rofit
com
panie
s a
nd o
ffer
nurs
ing c
are
+ d
iffe
rent
kin
ds o
f H
H. (N
= 3
,622)
said
OP
in n
eed o
f care
or
help
doesn't r
eceiv
e
enough. C
om
ple
menta
ry
serv
ices e
.g. shoppin
g,
vis
itin
g, accom
panyin
g to
docto
rs a
nd o
ther
local
serv
ices, gard
enin
g a
nd
household
main
tenance
not off
ere
d d
espite h
igh
need f
or
such "
light"
ser-
vic
es. R
egio
nal variations
e.g
. B
rem
en S
C s
erv
ices
inclu
de: M
eals
on w
heels
,
FC
counselli
ng / d
iscus-
sio
n g
roups, org
aniz
ing
dom
estic c
are
giv
ing, help
with a
uth
orities, filli
ng
form
s, household
tasks,
laundry
, cookin
g, w
alk
s,
vis
itin
g the d
octo
r and
colle
cting p
rescribed
rem
edie
s
Means teste
d s
ocia
l assis
-
tance is a
vaila
ble
to fin
ance
HH
. T
he O
P o
r F
C c
ontr
act
with the s
ocia
l serv
ice c
entr
e
where
am
ount and type o
f
assis
tance is laid
dow
n. T
he
contr
act costs
20,-
€ p
.m. and
every
serv
ice h
our
after
that
costs
7,1
5 €
. T
his
sum
is
seen a
s c
om
pensation for
the
mostly v
olu
nta
ry w
ork
ers
.
If H
H is n
eeded a
nd n
o n
eed
for
care
dete
rmin
ed then the
OP
or
the F
C m
ust
pay for
it.
Com
munity c
are
and m
eals
on w
heels
are
refinanced
either
by the p
ers
onal contr
i-
butions f
rom
the c
onsum
er
or
part
ly fro
m the s
ocia
l w
elfare
off
ice.
Day c
are
- W
hen O
P a
re
entitled to b
enefits
the L
TC
I
pays a
ll c
are
-rela
ted c
osts
over
an indefinite p
eriod.
Socia
l care
is p
aid
for
as w
ell
as m
edic
al tr
eatm
ent care
Inad
eq
uate
qu
ality
co
ntr
ol
2001 a
dditio
nal le
gis
lation to
guara
nte
e c
ert
ain
qualit
y levels
thro
ugh the L
TC
I. L
TC
I and
serv
ice p
rovid
ers
must agre
e
contr
acts
, re
gula
ting q
ualit
y
sta
ndard
s b
ut th
ese r
efe
r only
to s
tructu
res a
nd p
rocess r
ath
er
than o
utc
om
es o
f care
No g
enera
l m
onitoring b
ody
whic
h lays d
ow
n c
rite
ria for
the
assessm
ent of serv
ice q
ualit
y in
out-
patient health c
are
.
Tra
inin
g –
adequate
–m
ostly
train
ed T
he f
am
ily c
are
r / socia
l
assis
tant are
qualif
ied N
o s
tate
contr
olle
d tra
inin
g p
rogra
mm
e
but specia
list com
munity c
are
train
ing is o
ffere
d b
y v
arious
educational in
stitu
tions.
112
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
113
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Gre
ece
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres A
third (
253)
of LA
s h
ave h
om
e
help
serv
ices in 2
85 o
pera
ting u
nits;
47%
of users
liv
ed a
lone. G
row
th in
covera
ge. S
om
e c
oord
inate
d w
ith s
ocia
l
& h
ealth c
entr
es for
OP
.
Day C
are
cen
tres –
a few
have just
sta
rted
Ho
me h
ealt
h c
are
- Inadequate
Dem
en
tia s
erv
ices –
a few
support
serv
ices
Resp
ite c
are
– n
o s
erv
ices
.
Fre
e a
t poin
t of
use. A
lthough
prim
arily
desig
ned f
or
OP
alo
ne, m
any c
over
FC
s t
hat
need s
upport
.
Private
care
– lim
ited h
om
e
serv
ices e
xcept fo
r re
sid
ent
mig
rant w
ork
ers
– c
osting
appro
x 5
-600 €
wages +
low
rate
of
insura
nce f
or
those
who a
re legitim
ate
. C
heaper
than r
esid
ential care
.
Health c
are
requires info
rmal
paym
ents
especia
lly for
hom
e
vis
its.
Inad
eq
uate
qu
ality
co
ntr
ol
Adm
inis
trative c
rite
ria.
Tra
inin
g –
Ad
eq
uate
. M
ostl
y
train
ed
Hom
e h
elp
serv
ices –
headed b
y tra
ined S
W.
Hungary
H
om
e H
elp
and L
ocal co
ord
inati
on
cen
tres 2
% o
f 60+ r
eceiv
e H
H. 4.5
% o
f
OP
get in
stitu
tional help
fro
m the L
A in
case o
f ill
ness a
nd n
urs
ing; pro
port
ion
hig
hest in
Budapest (8
.2%
) and low
est
in v
illages (
3.3
%).
Day C
are
cen
tres –
som
e h
ave s
tart
ed
Ho
me h
ealt
h c
are
- Inadequate
Dem
en
tia s
erv
ices –
Resp
ite c
are
– s
om
e in d
ay c
are
cen-
tres h
ave s
tart
ed
Run b
y L
As a
s m
andato
ry
serv
ice. LA
may c
ontr
act
out
the t
ask t
o a
civ
il or-
ganis
ation o
r m
ark
et acto
r
under
an a
gre
em
ent or
contr
act. 2
2.9
% o
f all
recip
ients
of H
H liv
ed in
sm
all
agein
g s
ettle
ments
12.6
% o
f all
pers
ons r
e-
ceiv
ing m
eals
. H
ot m
eals
import
ant. f
am
ily h
elp
centr
es s
upport
FC
S o
f all
kin
ds
Fre
e f
or
FC
s. F
undin
g
thro
ugh L
As a
nd n
um
ero
us
NG
Os -
70,0
00– 1
5%
for
health / s
ocia
l care
. F
unded
by s
tate
(26.2
%),
ow
n r
eve-
nues (
52.7
%)
and p
rivate
support
Hungarian R
ed C
ross
and the H
ungarian M
altese
Charity
Serv
ice p
lay im
por-
tant ro
le in p
rovid
ing a
hig
h
sta
ndard
serv
ice fre
e o
f
charg
e a
nd innovato
ry. A
ll
FC
s a
nd O
P in n
eed a
re e
li-
gib
le.
Health c
are
requires info
rmal
paym
ents
Ad
eq
uate
qu
ality
co
ntr
ol
Budapest P
ublic A
dm
inis
tration
Offic
e u
sin
g e
xpert
s o
f 2 n
on-
sta
te institu
tions (
Foundation
for
Socia
l In
novation, H
ungar-
ian A
ssocia
tion o
f S
ocia
l D
irec-
tors
) – H
H a
lso s
uperv
ised b
y
Meth
odolo
gy C
entr
e o
f th
e
Hungarian M
altese C
harity
serv
ice. B
ut in
adequate
inte
gra
-
tion b
etw
een h
ealth a
nd s
ocia
l
serv
ices.
Tra
inin
g –
Ad
eq
uate
. M
ostly
train
ed c
are
rs in the h
om
e h
elp
serv
ice a
re n
urs
es P
art
icip
ation
in tra
inin
g o
n q
ualit
y a
ssura
nce
114
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
. is
im
port
ant
115
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Irela
nd
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres 8
0%
recip
ients
eld
erly, le
ss
than 1
/ 3
0 g
et serv
ice P
rovis
ion b
y
health b
oard
s. 5%
aged 7
5+
. 2007 a
im
is to c
over
25%
of th
ose a
ged 7
5+
(by
2020 e
stim
ate
d 5
% o
f 80+
.pop. and
10%
60+
in n
eed o
f care
) 133,0
00 o
f
whic
h 1
5,9
01 (
2%
govern
ment sup-
port
ed)
Lim
ited p
rivate
hom
e c
are
Day C
are
cen
tres –
. In
adequate
cov-
era
ge e
.g. hom
e c
are
, day c
entr
es.
Larg
e e
xpansio
n p
lanned
Ho
me h
ealt
h c
are
Good G
P, T
hera
py
3%
Dem
en
tia s
erv
ices –
som
e thru
’
NG
Os, m
ore
pla
nned in H
N s
erv
ices
and d
ay c
are
centr
es
Resp
ite c
are
- part
ial -
regio
nal varia-
tions b
y the h
ealth b
oard
or
NG
Os
Inadequate
HH
and D
ay
Care
in c
overa
ge a
nd
am
ount, a
nd g
eogra
phic
al
inequalit
ies. a, ty
pe o
f
conditio
n / d
isabili
ty e
tc.
Uncle
ar
entitlem
ent,
anom
alie
s a
nd inequali-
ties
Chiropody v
ery
popula
r –
16%
(of a s
am
ple
of 937
in H
eS
SO
P s
tudy)
use it
12%
would
have lik
ed to
use it but could
not ac-
cess the s
erv
ice. A
ll
health b
oard
s p
rovid
e H
H
but depends o
n d
em
and.
Barr
ier
to u
se –
lack o
f
know
ledge 1
4%
fin
d it
difficult. S
tigm
a-
30%
for
meals
on w
heels
& 2
0%
Hom
e H
elp
medic
al card
(fo
r lo
w incom
e
indiv
iduals
and fam
ilies a
nd
free for
all
aged 7
0+
)
Private
serv
ices d
epend o
n
incom
e.
Tax r
elief fo
r em
plo
ym
ent of
private
care
r– m
eans-t
esting
Applies t
o a
ll serv
ices
Inad
eq
uate
qu
ality
co
ntr
ol
No
usually in p
lace. Lin
e m
anage-
ment – d
iscre
te r
eport
ing s
ys-
tem
.
Tra
inin
g-
Inadequate
. M
any
untr
ain
ed
The a
bove a
pplie
s to h
om
e
help
only
Work
ers
in d
ay c
are
centr
es,
dem
entia a
nd r
espite s
erv
ices
all
underg
o tra
inin
g.
Italy
H
om
e H
elp
and L
ocal co
ord
inati
on
cen
tres 1
% o
f 65+ g
et hom
e c
are
ser-
vic
es d
iscrim
ination a
gain
st ru
ral are
as
and s
outh
ern
regio
ns. In
adequate
cov-
era
ge a
nd d
em
and e
xceeds p
rovis
ion.
Day C
are
cen
tres inte
gra
ted c
entr
es
are
very
positiv
e
Ho
me h
ealt
h c
are
- p
art
ial, r
egio
nal
diffe
rences
Pro
ble
matic r
ela
tionship
betw
een f
am
ilies a
nd the
public s
erv
ice n
etw
ork
,
where
serv
ices c
onsid
-
ere
d the m
ost help
ful are
,
at th
e s
am
e tim
e, per-
ceiv
ed a
s the m
ost in
-
adequate
(com
munity
care
centr
es, availa
bili
ty
of m
edic
ines, hom
e c
are
Moneta
ry tra
nsf
ers
in s
outh
and r
ura
l are
as a
re o
ften the
only
kin
d o
f support
available
to fam
ily c
are
rs b
ecause o
f
the lack o
f serv
ices.
Inad
eq
uate
qu
ality
co
ntr
ol
LA
s c
ontr
ol and a
ccre
dit b
ut no
cle
ar
norm
s a
nd d
efinitio
ns.
They f
und a
nd identify
min
imum
serv
ice s
tandard
s to a
ccre
dit a
ll
those p
rovid
ers
that re
spond to
these r
equirem
ents
.
Tra
inin
g-
part
ial -
yes for
pro
-
fessio
nal le
vel, B
ut fo
r lo
wer
116
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Dem
en
tia s
erv
ices -
part
ial
Resp
ite c
are
– n
one a
t hom
e
assis
tance, specia
lized
health c
entr
es for
Alz
-
heim
er’s d
isease, m
one-
tary
pro
vis
ions a
nd h
om
e
health c
are
)
level w
ork
ers
attem
pts
at R
e-
gio
nal le
vel, b
ut m
any u
nquali-
fied.
Luxem
bourg
H
om
e H
elp
and L
ocal co
ord
inati
on
cen
tres. Y
es. M
in. 3.5
hrs
per
week to
qualif
y for
OP
(dependent pers
on)
No p
rivate
serv
ices
Day C
are
cen
tres –
yes 7
centr
es r
un
by a
n N
GO
for
psycho-g
eriatr
ic c
ases
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e
Dem
en
tia s
erv
ices -
yes
Resp
ite c
are
– y
es (
3 w
ks p
er
year)
and fin
anced b
y d
ependency insura
nce.
2 F
oundations in c
harg
e
of aid
s a
nd s
erv
ices
within
fra
mew
ork
of de-
pendency insura
nce. O
ne
of th
eir c
oord
inato
rs v
isits
OP
and F
C a
fter
notifica-
tion fro
m U
nio
n o
f S
ick-
ness F
unds.
NG
Os r
unnin
g r
espite
care
serv
ices f
unded b
y
Min
istr
y.
All
needin
g h
elp
covere
d b
y
dependency insura
nce. P
ar-
tially
qualif
ied u
nder
SI be-
com
e e
ligib
le a
fter
1 y
ear.
Dependent O
P r
eceiv
es n
urs
-
ing a
llow
ance o
f 23.8
5 €
p.h
.
that can b
e u
sed to b
enefit
FC
. >
7 h
ours
care
p.w
. can
be u
sed b
y info
rmal care
r. 7
-
14 h
rs –
serv
ice n
etw
ork
s
must pro
vid
e h
alf the h
ours
.
14+
hours
per
week –
com
-
ple
tely
pro
vid
ed b
y h
elp
ser-
vic
es. D
ependent O
P r
e-
ceiv
es a
nnually d
ouble
the
am
ount of nurs
ing a
llow
ance
to fin
ance r
espite c
are
and
giv
e F
C tim
e f
or
recre
ation.
Tem
pora
ry s
tay in n
urs
ing
hom
es d
irectly fin
anced b
y
dependency insura
nce
Ad
eq
uate
qu
ality
co
ntr
ol
Pub-
lic e
valu
ation c
ente
r (C
EO
)
pro
vid
es e
stim
ate
s o
f needs f
or
care
and o
f benefits
needed
under
the d
ependency insur-
ance. C
EO
advis
es the U
nio
n
of S
ickness F
unds w
ho c
lassify
dependency, pay for
nurs
ing
serv
ices, negotiate
with s
er-
vic
es for
pro
vis
ion o
f nurs
ing
aid
s. F
urt
her
qualit
y d
evelo
p-
ment assura
nce u
nder
devel-
opm
ent.
Tra
inin
g.-
Adequate
Mostly
train
ed, pla
ns to e
xte
nd tra
inin
g
Malta
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres Y
es. 30 d
iffe
rent serv
ices to
main
tain
ing O
P in c
om
munity.
Serv
ices
inclu
de H
andym
an S
erv
ice,
Hom
e C
are
Help
, In
continence S
erv
ice, M
eals
on
Cases d
iscussed b
y In-
tern
al B
oard
of A
llocation
of
Serv
ice a
fter
applic
a-
tion a
nd m
edic
al re
port
;
on a
ccepta
nce g
oes to
Fre
e
Som
e p
rivate
agencie
s p
ro-
vid
e
hom
e a
nd n
urs
ing c
are
;
Ad
eq
uate
qu
ality
co
ntr
ol
In-
tern
al B
oard
of A
llocation o
f
Serv
ice
Tra
inin
g-
Good-
Mostly tra
ined
117
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Wheels
, T
ele
care
, etc
.
Waitin
g lis
ts
Day C
are
cen
tres –
5%
of O
P in 1
4
are
as
Ho
me h
ealt
h c
are
- C
om
pre
hensiv
e
inclu
din
g D
om
icili
ary
Nurs
ing
Dem
en
tia s
erv
ices –
in d
ay h
ospital,
plu
s a
dvic
e thru
’ N
GO
.
Resp
ite c
are
– s
om
e o
rganis
ed b
y
NG
O.
the a
rea s
uperv
isor
where
OP
liv
es;
allo
cation o
f
hours
of
serv
ice to O
P
made o
n b
asis
of
real
needs.
Many F
Cs u
sin
g H
H s
er-
vic
es f
eel it a
n a
dm
issio
n
of th
eir inabili
ty to liv
e u
p
to f
am
ily e
xpecta
tions,
leadin
g to a
n u
neasy
part
ners
hip
betw
een F
Cs
and f
orm
al serv
ice p
ro-
vid
ers
.
charg
es d
epend o
n the n
um
-
ber
of hours
serv
ice u
sed. B
ut
not easily a
fford
able
by e
very
fam
ily.
2 w
eeks tra
inin
g p
rior
to r
e-
cru
itm
ent. F
or
part
tim
e S
ocia
l
Assis
tants
446,
main
ly e
m-
plo
yed a
s H
om
e h
elp
s w
ith v
ery
sm
all
no. of
OP
as c
lients
with
PT
SA
s s
ele
cte
d fro
m the s
am
e
are
a o
f th
e b
eneficia
ries in h
er
care
.
Oth
ers
e.g
. M
em
orial
Dis
tric
t N
urs
ing A
ssocia
tion,
pro
fessio
nally tra
ined.
Neth
erlands
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres r
egio
nal in
tegra
ted n
eeds a
s-
sessm
ent agencie
s; only
1 in 5
chro
ni-
cally
ill
or
dis
able
d p
ers
ons u
ses p
ro-
fessio
nal assis
tance.
Day C
are
cen
tres 1
7%
uses c
are
at-
tendance f
acili
ties a
nd 1
0%
report
s that
the p
ers
on they c
are
for vis
it d
ay c
are
facili
ties o
r activity c
entr
es
Ho
me h
ealt
h c
are
- C
om
pre
hensiv
e
Dem
en
tia s
erv
ices –
yes,
som
e p
ilot
pro
jects
*
Resp
ite c
are
– y
es a
wid
e r
ange o
f
form
s a
t hom
e, day c
are
, by form
al
serv
ices a
nd N
GO
s
36%
of F
Cs d
o n
ot ar-
range f
orm
al hom
e c
are
because the c
are
receiv
-
ers
do n
ot w
ant str
angers
in their h
ouse F
Cs o
f
som
eone r
eceiv
ing form
al
hom
e c
are
als
o m
ore
often u
se s
upport
ser-
vic
es f
or
FC
s (
info
rma-
tion, advic
e a
nd e
mo-
tional support
serv
ices)
(48%
V29%
of th
e c
are
receiv
ers
without fo
rmal
hom
e c
are
).
Pro
fessio
nal H
H r
e-
str
icte
d to f
ew
tasks:
washin
g / b
ath
ing, dre
ss-
ing O
P, heavy h
ousehold
Needs a
ssessm
ent. P
ers
onal
care
budget so p
eople
buy
ow
n c
are
and m
any s
mall
private
hom
e c
are
org
anis
a-
tions a
re a
risin
g.
Yes o
ut of pocket paym
ents
–
53%
report
ed n
o d
ifficultie
s in
meeting these. O
P a
fter
as-
sessm
ent and if elig
ible
for
non-institu
tional care
, can a
sk
for
care
in c
ash o
r kin
d. A
nd
can u
se it to
pay F
C / k
in
Ad
eq
uate
qu
ality
co
ntr
ol.
Independent org
anis
ation m
oni-
tor
the larg
e h
om
e c
are
org
ani-
sations w
hic
h c
an r
eceiv
e a
quality
sig
n. O
rganis
ations w
ork
with c
are
pla
ns (
set up togeth
er
with p
atient)
; P
rivacy g
uara
n-
tee; C
lient / re
sid
ents
’ com
mit-
tees; In
dependent C
om
pla
ints
com
mitte
es.
Sm
all
private
hom
e c
are
or-
ganis
ations n
ot m
onitore
d a
nd
contr
olle
d b
y g
overn
ment
Tra
inin
g. A
dequate
Mostly
train
ed c
om
puls
ory
for
all
levels
except th
e low
est le
vel
118
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
tasks if th
ere
is n
o F
C o
r
when there
’s a
longsta
nd-
ing a
nd inte
nsiv
e c
are
situation a
nd tra
nsfe
r to
intr
am
ura
l care
is thre
at-
ened.
Norw
ay
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres L
A p
rovid
ed. 30%
eld
erly 7
5+
receiv
ed form
al hom
e h
elp
serv
ices.
30%
of th
e n
on-institu
tional popula
tion
67+
in n
eed o
f help
to s
hop a
nd c
lean.
5%
needed c
are
fro
m o
thers
or
could
hard
ly m
anage to d
ress o
r ta
ke c
are
of
their d
aily
pers
onal hygie
ne o
n their
ow
n.
Day C
are
cen
tres –
yes in n
early a
ll LA
are
as e
xcept very
sm
all
LA
s.
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e
inclu
din
g locally
availa
ble
sta
tuto
ry
rehabili
tation f
acili
ties
Dem
en
tia s
erv
ices –
80%
of
LA
s h
ave
specia
l dem
entia s
erv
ices, and incre
as-
ing n
o. to
support
FC
s.
Resp
ite c
are
- yes b
y L
As a
nd N
GO
s
LA
responsib
ility
; fa
mily
pro
vid
es less instr
um
enta
l
and p
ers
onal care
, but
tota
l le
vel of
help
(fr
om
fam
ily a
nd s
erv
ices)
in
Norw
ay is h
igher
than in
countr
ies w
ith m
ore
fam
ily
dom
inate
d c
are
syste
ms
But in
suffic
ient
public
serv
ices, and fam
ilies
supply
more
care
than
they fin
d r
easonable
.
Som
e F
Cs g
ive c
are
at
the c
ost of th
eir o
wn
health a
nd w
elfare
.
Part
co-p
aym
ent. L
A p
ays
All
in n
eed-
dis
abili
ty b
ased,
Indiv
idual entitlem
ent – e
ven
if F
C a
vaila
ble
.
Ad
eq
uate
qu
ality
co
ntr
ol.
Superv
isio
n legis
lation. LA
re-
sponsib
le.
Tra
inin
g-
Good, M
ost tr
ain
ed
Pola
nd
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres S
ocia
l care
at LA
, county
, re
-
gio
n. In
2002 L
A s
erv
ices w
ere
used b
y
81.2
thousand p
eople
2-3
tim
es p
er
week, 2 h
ours
serv
ices
Com
munity a
ssis
tance
inclu
des fin
ancia
l assis
-
tance (
main
ly p
erm
anent,
tem
pora
ry a
nd inte
ntional
benefits
) and s
erv
ices –
(e.g
. hom
e n
urs
ing s
er-
HH
dependent on the incom
e
and e
stim
ate
d n
eeds o
f all
the m
em
bers
of
the h
ouse-
hold
Fre
e.
But
co-p
aym
ents
for
Inad
eq
uate
qu
ality
co
ntr
ol.
Adm
inis
trative m
ain
ly.
NG
Os -
contr
ol is
restr
icte
d to
the fin
ancia
l aspects
and legal
basis
of
their a
ctivity a
nd fulfill
-
119
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Day C
are
cen
tres -
LA
s; N
os d
ecre
as-
ing.-
213
Dem
en
tia s
erv
ices –
not at hom
e
Ho
me h
ealt
h c
are
- inadequate
Resp
ite c
are
- no
vic
es, la
undry
serv
ices).
no s
ocia
l serv
ices m
ark
et,
whic
h w
ould
allo
w s
ocia
l
care
centr
es to b
uy s
er-
vic
es for
eld
erly a
nd d
is-
able
d fro
m N
GO
S o
r pri-
vate
Cos. 418.3
00
(160.7
00 1
pers
on
household
s)
household
s.
¾ in c
itie
s. N
.B. E
arlie
r
attem
pts
to inte
gra
te H
and S
S led to low
er
sta
tus o
f soc. C
are
work
-
ers
– c
urr
ent separa
tion
has incre
ased e
quality
medic
ines a
re h
eavy b
urd
en
for
FC
s,. P
lus p
aym
ents
to
attend p
rivate
clin
ics
ing their c
ontr
acts
.
Tra
inin
g. A
dequate
6,5
00 e
m-
plo
yees in S
ocia
l C
are
Centr
es
+ m
any v
olu
nte
ers
and e
mplo
y-
ees in N
GO
s +
11,0
00 S
ocia
l
Care
Centr
es e
mplo
yin
g 1
1,0
00
for
specia
lised c
are
.
Port
ugal
Hom
e H
elp
and L
ocal coord
ination
centr
es –
attem
pts
to inte
gra
te H
and
SS
.
Day C
are
centr
es g
row
th in n
os.
41,1
95 p
laces in 1
998
Ho
me h
ealt
h c
are
- inadequate
Dem
en
tia s
erv
ices -
no
Resp
ite c
are
- not in
hom
e, ra
re
S
mall
charg
e for
day c
are
Costs
for
usin
g s
om
e h
ealth
serv
ices a
t hom
e.
Inad
eq
uate
qu
ality
co
ntr
ol.
SW
specia
lists
undert
ake c
on-
trol and c
onsultations. C
ontr
ol
of econom
y o
f socia
l care
insti-
tutions b
ased o
n a
nnual (o
r
quart
erly)
activity r
eport
s. C
on-
trol over
NG
Os lim
ited to their
serv
ice c
ontr
acts
and the fin
an-
cia
l support
fro
m the m
inis
try.
Most of th
is c
ontr
ol is
restr
icte
d
to fin
ancia
l aspects
and legal
basis
of
the N
GO
’s a
ctivity.
Tra
inin
g –
inadequate
- som
e
attem
pts
to s
tart
wid
er
train
ing.
Slo
venia
H
om
e H
elp
and L
ocal co
ord
inati
on
cen
tres a
round 5
,000 p
eople
receiv
e
The c
urr
ent org
anis
a-
tional crisis
in h
ealth c
are
LA
vary
but socia
l hom
e a
s-
sis
tance s
ubsid
ised a
ppro
x.
Inad
eq
uate
qu
ality
co
ntr
ol.
120
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
public h
om
e h
elp
. by
52 c
entres
for so
cia
l
work
, 5 o
ld p
eople
’s h
om
es
and 3
priv
ate
pro
vid
ers
Day C
are
cen
tres 2
0 O
P h
om
es h
ad
centr
es; w
ith c
apacity for
aro
und 3
00
people
Ho
me h
ealt
h c
are
- inadequate
Dem
en
tia s
erv
ices –
NG
Os h
ave
sta
rted s
upport
serv
ices
Resp
ite c
are
– n
o
syste
m h
as s
ubsta
ntially
reduced n
urs
ing c
are
.
Physic
al conditio
n
70%
. T
his
serv
ice is n
ot
equally d
evelo
ped in a
ll m
u-
nic
ipalit
ies.
Num
bers
of
socia
l care
rs
declinin
g b
ecause o
f la
ck o
f
fundin
g for
LA
s.
Tra
inin
g –
mix
ed -
inadequate
.
qualif
ied h
om
e h
elp
sta
ff=
660;
Hom
e a
ssis
tants
can b
e e
x-
pert
s o
r pers
ons w
ho o
bta
ined
1 y
r tr
ain
ing for
hom
e s
ocia
l
care
rs, confirm
ed b
y the S
ocia
l
Cham
ber
of S
lovenia
. (1
year
part
tim
e-
168 s
chool hours
.
The p
ositio
n o
f a s
ocia
l care
r is
not a h
ealth p
rofe
ssio
n. T
rain
ed
nurs
e-c
are
rs
Spain
H
om
e H
elp
and L
ocal co
ord
inati
on
cen
tres S
harp
Incre
ase in d
em
and.
(75%
in 3
yrs
) 2.8
0%
of
65+
attended
by H
H s
erv
ice. 1 in 1
5 o
f th
ose a
ged
75+
. m
ain
ly w
om
en (
over
60%
); 5
3%
< 8
0 y
rs. A
v. 3.5
-4 h
ours
a w
eek p
er
pers
on, m
ean c
ost 9.5
€. p.h
.
1.4
8%
65+
get public
tele
-assis
tance
serv
ice, in
10+ o
f th
e 1
7 a
uto
nom
ous
com
munitie
s, in
cre
ase in d
em
and b
y
114.7
5%
.
70%
+ o
f H
H u
ndert
aken in p
rivate
secto
r.
Only
8%
of popula
tion w
ould
wis
h to b
e
attended o
nly
by the p
ublic
SS
and
12%
would
wis
h to b
e a
ttended b
y the
fam
ily a
nd the S
S togeth
er.
Day C
are
cen
tres 0
.11%
dependent
HH
care
pro
gra
mm
es in
Cata
lonia
in 9
0%
of th
e
prim
ary
care
centr
es,
more
than 7
5%
off
er
care
r tr
ain
ing a
nd a
lmost
69%
specific
“caring for
the c
are
r” p
rogra
mm
es.
Co-p
aym
ents
. H
om
e h
elp
is
expensiv
e-
the h
ourly s
erv
ice
costs
more
than 1
7 €
). W
here
OP
receiv
ed the f
undin
g (
or
the F
C)
they u
se m
oney for
irre
gula
r contr
acts
by the
hour,
without assum
ing the
corr
espondin
g labour
costs
,
so the m
unic
ipal m
oney c
on-
trib
ute
s to n
urt
uring the s
ub-
merg
ed e
conom
y d
aily
In a
day c
entr
e, th
ey m
ust
contr
ibute
25%
of th
eir p
en-
sio
n
Inad
eq
uate
qu
ality
co
ntr
ol.
LA
s r
esponsib
le b
ut doubtful
quality
poor
mechanis
ms o
f co-
ord
ination b
etw
een s
erv
ices;
genera
l scarc
ity o
f th
e s
erv
ice
and the h
igh levels
of co-
paym
ent.
Tra
inin
g –
inadequate
for
Pro
-
fessio
nals
- th
eir p
rofile
not al-
ways s
uitable
for
the w
ork
, es-
pecia
lly in s
uperv
isio
n a
nd
managem
ent; the s
carc
e inte
r-
est of th
e w
ork
ers
in jobs c
on-
cern
ing the h
ygie
ne a
nd p
er-
sonal attention to the O
P; th
e
genera
l poor
connection b
e-
tween the w
ork
ers
and the u
s-
ers
;
121
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
people
used a
serv
ice,
Ho
me h
ealt
h c
are
- inadequate
Dem
en
tia s
erv
ices -
no
Resp
ite c
are
- n
o
Sw
eden
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres L
A d
ecid
e s
erv
ice level, e
ligi-
bili
ty c
rite
ria a
nd r
ange o
f serv
ices.
Sin
gle
-entr
y s
yste
m; O
P h
elp
ed b
y L
A
where
he liv
es.
2003, 8%
65 y
ears
+ g
ot H
H. O
f 80+,
19%
got H
H i.e
. despite g
row
th in p
opu-
lation n
um
bers
HH
less b
ut conta
ct
hours
incre
ased s
uccessiv
ely
i.e
. fe
wer
pers
ons g
et m
ore
help
. 28%
get H
H in
the e
venin
gs a
nd n
ight.
Com
pre
hensiv
e L
A s
erv
ices e
.g. tr
ans-
port
ation s
erv
ices, fo
ot
care
, m
eals
on
wheels
, security
ala
rms, housin
g a
dap-
tations, handic
ap a
ids, etc
.
LA
s s
tart
ed F
C r
esourc
e c
entr
es o
ffer-
ing tra
inin
g, counselli
ng, support
gro
ups, re
spite c
are
, and o
ther
info
rma-
tion a
nd r
esourc
es f
or
fam
ily c
are
giv
ers
Day C
are
cen
tres -
Yes p
rogra
ms for
dis
able
d f
am
ily m
em
ber
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e.
2.7
% 6
5+
get hom
e n
urs
ing c
are
Dem
en
tia s
erv
ices -
Yes
Need a
ssessm
ent by L
A
care
manager.
In s
om
e
LA
s inte
rdis
cip
linary
care
pla
nnin
g team
s for
as-
sessm
ent and c
o-
ord
ination o
f eld
erc
are
serv
ices f
requent, e
spe-
cia
lly c
oncern
ing a
per-
manent m
ove t
o institu
-
tional care
. 4%
of all
OP
with H
H r
eceiv
ed m
ore
than 1
20 h
ours
p.m
..
Co-p
aym
ent but th
ere
is a
cap o
n h
ow
much the u
ser
pays, to
ensure
they h
ave
incom
e left for
their o
wn e
x-
penses. In
more
than h
alf o
f
all
munic
ipalit
ies,
care
man-
agem
ent is
based o
n a
pur-
chaser
– p
rovid
er m
odel.
Private
, out of
pocket paid
health c
are
is e
xtr
em
ely
un-
usual
Ad
eq
uate
qu
ality
co
ntr
ol.
LA
monitors
plu
s s
uperv
isio
n b
y
the N
ational B
oard
of H
ealth
and W
elfare
(fo
cusin
g h
ealth
care
issues a
nd b
ased o
n the
Health C
are
Act)
and the
county
Adm
inis
trative B
oard
(focusin
g s
ocia
l serv
ice issues
and b
ased o
n the S
ocia
l S
er-
vic
es A
ct)
.
Tra
inin
g. G
ood
192 0
00 p
ers
ons (
hom
e h
elp
-
ers
/ n
urs
es a
ids)
were
em
-
plo
yed in the h
om
e h
elp
ser-
vic
es. 25%
were
full-
tim
e e
m-
plo
yed, nearly 6
0 p
er
cent
work
ed p
art
-tim
e a
nd the r
est
were
on a
n h
ourly b
asis
em
-
plo
ym
ent.
122
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
Resp
ite c
are
- yes
Sw
itzerland
Ho
me H
elp
and L
ocal co
ord
inati
on
cen
tres –
larg
e v
ariations b
etw
een
canto
ns; som
e p
rovid
e H
H o
thers
do
not.
Day C
are
cen
tres –
som
e, unequal
covera
ge, attached to h
ospitals
or
run
by N
GO
s e
.g.
Spitex
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e.
Palli
ative c
are
at hom
e a
lso a
vailable
Dem
en
tia s
erv
ices –
90,0
00 p
ers
ons
affecte
d b
y A
lzheim
er
Resp
ite c
are
- very
little.
Cannot genera
lize r
esults
as c
anto
ns im
ple
ment
very
diffe
rent polic
ies in H
& S
S
a third o
f th
e e
lderly d
e-
cla
re they d
on’t w
ant
hom
e c
are
serv
ices b
e-
cause they d
on’t w
ant
fore
igners
at hom
e.
Costs
of
hom
e n
urs
ing n
ot
fully
covere
d b
y H
I
The e
conom
ic v
alu
e o
f F
C
work
has b
een c
alc
ula
ted to
reach b
etw
een 1
0 a
nd 1
2
bill
ions o
f S
wis
s F
rancs, ex-
ceedin
g the c
um
ula
ted
spendin
g o
f both
the H
C s
er-
vic
es a
nd the O
P h
om
e o
f
Sw
itzerland
Ad
eq
uate
qu
ality
co
ntr
ol.
Tra
inin
g-
only
for
health p
er-
sonnel. Inadequate
for
oth
ers
.
UK
H
om
e H
elp
and L
ocal co
ord
inati
on
cen
tres. LA
s n
ow
giv
e m
ore
inte
nsiv
e
serv
ices to less u
sers
. 2002 a
v. conta
ct
hours
for
each o
f th
e s
upport
ed
366,8
00 h
ousehold
s =
8.1
hours
. 41%
of th
ose n
eedin
g c
are
get vis
its fro
m
H&
SS
or volu
nte
ers
64%
pro
vid
ed b
y the independent sec-
tors
, up fro
m 4
2%
5 y
ears
ago
Day C
are
cen
tres 6
5-7
4 y
ear
age
gro
up, 32%
of
care
d-f
or
people
attend
som
e form
of
daily
clu
b o
r day c
are
/
hospital, w
ith the fig
ure
bein
g 2
9%
in
those a
ged 8
5 a
nd o
ver
Ho
me h
ealt
h c
are
- c
om
pre
hensiv
e
Wheth
er
the h
ousehold
was involv
ed in h
eavy
care
did
not add s
ignifi-
cantly t
o the lik
elih
ood o
f
usin
g s
erv
ices.
(41%
) of care
d-f
or
peo-
ple
(of all
age g
roups)
receiv
e v
isits fro
m h
ealth,
socia
l or
volu
nta
ry s
er-
vic
es. V
isits low
er
if liv
ed
with F
C c
are
r (2
3%
) V
in
anoth
er
household
(50)
e.g
. hom
e h
elp
/ m
eals
on
wheels
(9%
/ 3
1%
).
People
liv
ing in the s
am
e
Aft
er
assessm
ent
by S
ocia
l
serv
ices-
means a
nd n
eeds
teste
d.
Ad
eq
uate
qu
ality
co
ntr
ol.
Socia
l serv
ices -
lin
e m
anage-
ment and r
eport
ing s
yste
ms
back thro
ugh to a
n E
xecutive
Directo
r.
Exte
rnal pro
vid
ers
such a
s v
ol-
unta
ry o
rganis
ations o
r com
-
merc
ial secto
rs a
re m
anaged
by their o
wn m
anagers
/ o
wn-
ers
/ c
om
mitte
e / b
oard
. N
a-
tional C
are
Sta
ndard
s C
om
mis
-
sio
n g
uara
nte
es q
uality
.
All
purc
hased h
om
e c
are
ser-
vic
es a
re d
eliv
ere
d u
nder
con-
tract w
ith a
legal F
orm
of
123
Co
un
trie
s
Availab
ilit
y o
f H
om
e B
ased
serv
ices
Hom
e H
elp
and L
ocal coord
ination
centr
es; D
ay C
are
centr
es; P
ublic s
ec-
tor;
Hom
e H
ealth c
are
– D
em
entia s
er-
vic
es; R
espite c
are
in the h
om
e
Ad
dit
ion
al co
mm
en
ts
Co
sts
of
usin
g s
erv
ice c
are
Aff
ord
ab
ilit
y
Qu
ality
& c
on
tro
l o
f serv
ice –
ISO
.
Tra
inin
g o
f W
ork
ers
with c
hiropody a
nd H
V o
r dis
tric
t nurs
e
bein
g m
ost popula
r.
Dem
en
tia s
erv
ices –
Alz
heim
er
Assoc.
has 2
5,0
00 m
em
bers
,300 b
ranches a
nd
support
gro
ups; giv
es info
rmation a
nd
education for
people
with d
em
entia,
FC
s. &
pro
fessio
nals
. ru
ns q
uality
day
and h
om
e c
are
,
Resp
ite c
are
- yes, w
as the e
ssential
serv
ice in s
upport
ing F
Cs b
ut fu
ndin
g
no longer
guara
nte
ed for
this
purp
ose.
household
as the c
are
r
are
less lik
ely
to r
eceiv
e
vis
its fro
m h
ealth p
racti-
tioners
(15%
/ 3
0%
Agre
em
ent and a
deta
iled S
er-
vic
e S
pecific
ation. T
heses a
re
subje
ct to
quart
erly m
onitoring,
Annual S
erv
ices R
evie
ws a
nd
independent serv
ice u
ser
sur-
veys r
un b
y S
SD
Contr
acts
Unit. IS
Os.
Tra
inin
g –
adequate
124
5.9
A
nn
ex 9
– M
atr
ix:
Care
of
de
pe
nd
en
t o
lder
Pe
op
le –
cu
rre
nt
an
d f
utu
re S
up
ply
of
form
al
an
d i
n-
form
al
Care
Giv
ers
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
Austr
ia
40%
work
and c
are
.
above a
v. F
or
those w
ith low
sta
tus jobs
55%
liv
ed w
ith o
r adja
cent to
OP
. 2 / 3
of dependent O
P
get F
C
Only
0.5
% o
f A
ustr
ians lis
t
no o
ne u
pon w
hom
they c
an
rely
in m
inor
cases o
f need.
In s
erious c
ases o
f need a
s
well there
are
few
people
(1.7
%)
who c
onsid
er
them
-
selv
es w
ithout any s
upport
from
rela
tives o
r fr
iends.
Better
educate
d
+ those w
ith
better
jobs less
willin
g to c
are
.
Low
wage s
ec-
tor-
7.5
-8 p
r
hour.
Pro
ble
ms I
gettin
g h
elp
at
weekends a
nd
nig
ht.
Short
age o
f
hom
e h
ealth
nurs
es.
Yes-
re-
privatization o
f
care
.
Yes.
Young m
en
can u
ndert
ake
care
inste
ad
of m
ilita
ry
serv
ice
Larg
e g
rey L
M o
f
mig
rants
as c
are
and d
om
estic
work
ers
fro
m E
Euro
pe. E
.g.
Czech R
epublic
or
Hungary
. E
s-
tim
ate
d c
osts
for
a 2
4-h
our
in-
hom
e s
erv
ice a
re
aro
und 1
,400 €
p.m
..
1.
Yes –
part
ly
paid
for-
done
by N
GO
s a
nd
LA
2.
Yes –
no n
a-
tional re
gula
-
tions o
r sta
n-
dard
s
3.
Yes-
som
e b
ut
many n
ot
train
ed
Belg
ium
5.8
9%
of
Belg
ians 1
6+
were
caring w
ithout pay for
som
e-
one w
ho is ill,
dependent or
eld
erly.2
/ 3
care
d for
by
fam
ily –
no c
hange
Maj aged 4
4-7
6, 69.3
3%
fem
ale
. 66.3
6%
marr
ied.
More
lik
ely
than n
on c
are
rs
to b
e p
ensio
ners
, house-
wiv
es o
r unem
plo
yed. O
f
those in p
aid
work
, 30%
in
Gre
ate
r m
obili
ty
and less F
C
available
makes
futu
re c
are
diffi-
cult.
Belg
ian L
M-
53.3
7%
men,
31.9
2%
wom
en
aged 5
0-6
5 a
c-
tive in L
M
Dem
and f
or
hom
e s
erv
ices
larg
er
than s
up-
ply
Difficultie
s in
findin
g c
ert
ifie
s
nurs
es
Good r
esid
ential
care
.
Govt. a
ttem
pting
No info
rmal
unre
gis
tere
d
care
rs.
Na d
ata
Yes –
sit in
No d
ata
1.
Yes –
fro
m
subsid
ized
care
rs’ gro
ups
2.
Yes
3.
Yes-
sit in
serv
ices.
125
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
pt / tim
e. 39.2
6%
15 h
rs p
er
week;
4%
sto
pped t
em
p.
work
because o
f caring. A
v
17.5
hrs
care
per
week
(1 >
99)
59%
liv
e in s
am
e
household
. 14.8
9%
hus-
bands, 46.8
2 p
are
nts
,
14.3
3%
in law
s, oth
er
fam
ily
care
d for
16.9
9%
non fam
ily
= 1
3.3
1%
Bre
akdow
n b
y those n
eedin
g
care
and a
ge.
2 / 3
of care
from
fam
ilies b
ut
OP
thin
k f
am
i-
lies less w
illin
g
to c
are
.
to im
pro
ve w
ork
-
ing c
onditio
ns
and w
ages.
11,0
00 s
elf e
m-
plo
yed n
urs
es –
30%
not ft / tim
e
in s
elf e
mpl. b
ut
work
in h
ospitals
Bulg
aria
20%
unem
plo
ym
ent and 1
mill
ion é
mig
rés leaves m
any
OP
without F
Cs
Unknow
n
Inadequate
,
bad, irre
gula
r
pay. B
ut a larg
e
supply
of quali-
fied p
ers
onnel.
Yes-
gro
wth
in
hire o
f private
care
rs (
thro
ugh
mig
rant re
mit-
tances)
Yes.
- 1.
–
2.
Yes
3.
Yes f
or volu
n-
teers
Czech
Republic
Childre
n (
53%
), s
pouse
(21%
), friends (
16%
) and
rela
tives (
10%
). F
Cs-
64%
wom
en 3
6%
of m
en. 80%
of
care
pro
vid
ed a
t hom
e.
Appro
x. 100 0
00 s
enio
rs
need a
ssis
tance w
ith b
asic
AD
L, about 300 0
00 s
enio
rs
need a
ssis
tance w
ith IA
DL.-
appro
x. 400-
500 0
00 F
Cs.
The a
vera
ge tim
e p
eriod o
f
this
type o
f care
is 4
-5 y
ears
.
Wom
en o
f LM
age a
re the
Hig
h r
ate
s o
f
em
plo
ym
ent
am
ongst w
om
en
till
55.
Even in r
egio
ns
with a
hig
h u
n-
em
plo
ym
ent ra
te
there
may b
e
vacancie
s in
socia
l care
. T
he
level of
incom
e
receiv
ed b
y
caring p
rofe
s-
sio
nals
is s
o low
that m
any p
eo-
ple
pre
fer
to s
tay
rath
er
unem
-
No d
ata
but
som
e f
rom
ex
Sovie
t U
nio
n in
non r
egis
tere
d
dom
estic w
ork
–
126
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
most fr
equent
care
giv
ers
.
80%
are
em
plo
yed.
plo
yed than to
work
with o
lder
people
.
Denm
ark
M
ax. 55%
OP
get help
with
cert
ain
tasks w
ith p
rim
ary
pro
vid
ers
bein
g s
pouses a
nd
childre
n –
but no a
ccura
te
data
– M
ost help
is for
house, tr
ansport
.
fem
ale
labour
forc
e p
art
icip
a-
tion r
ate
s o
ne o
f
hig
hest A
ged
44-5
0 e
xpect to
spend m
ore
tim
e
with F
C than
old
er
genera
-
tions.
100,0
00 f
ull-
tim
e
em
plo
yees.
2.0
01 to 2
002,
the%
gro
wth
in
the n
um
ber
of
full-
tim
e e
m-
plo
yees in the
care
secto
r fo
r
old
er
people
at
4.4
per
cent w
as
more
than thre
e
tim
es the g
row
th
in the n
um
ber
of
old
er
people
aged 8
0 y
ears
and o
ver
in that
year
(1.4
per
cent)
.
Tra
inin
g a
ims to
addre
ss r
ecru
it-
ment pro
ble
ms
in the c
are
(fo
r
old
er
people
)
secto
r. 9
0%
fem
ale
- attem
pts
to a
ttra
ct m
en.
Sam
e a
s p
ublic
Yes
No d
ata
– lim
ited
use o
f private
work
s b
ut
120,0
00 f
ore
ign
work
ers
of
whom
20 p
er
cent w
ere
from
centr
al and
Easte
rn E
uro
-
pean c
ountr
ies
and 2
4 p
er
cent
were
fro
m A
sia
1.
–
2.
Yes-
basic
train
ing s
yste
m
in p
hases, in
-
cre
ase m
otiva-
tion for
furt
her
train
ing
14-2
0 m
onth
s
for
dom
estic
work
, and o
ver
95%
of th
ose
work
ing w
ith
old
er
people
have this
level
of tr
ain
ing.
Tra
inees r
e-
ceiv
e a
sala
ry
as a
tra
ined
work
ing c
are
work
er.
3.
–
127
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
Fin
land
43%
spouses, 22%
childre
n,
22%
pare
nts
(all k
inds o
f
FC
s)
30%
aged 1
8-4
9
33%
40-6
4
39%
65+
Men 2
5%
of F
Cs
More
sin
gle
pers
on h
ouse-
hold
s o
f 75 +
years
Huge incre
ase
in n
o o
f O
lder
wom
en w
ork
ing
and a
ttem
pts
to
incre
ase this
furt
her
Short
ages f
ore
-
seen
Incre
ase in n
o.
of m
en c
are
rs
Short
age o
f
work
ing a
ge
people
.
Pro
ble
m o
f re
-
tention low
sala
-
ries a
nd e
mi-
gra
te to w
ork
els
ew
here
.
Incre
ase o
f 25%
in p
ers
onnel
Yes e
sp. pen-
sio
ners
. B
ut
NG
Os n
eed
volu
nte
ers
.
Info
rmal care
accounts
for
only
1%
of
care
.
Low
availabili
ty
1.
yes b
y C
are
rs
associa
tions
2.
yes
3. F
innis
h R
ed
Cro
ss a
nd
Churc
h
Fra
nce
Nos incre
ased w
ith d
eclin
e
of old
er
wom
en’s
LM
part
ici-
pation. 3,2
% in r
esid
ential
hom
es, 0,6
% p
rofe
ss h
elp
only
. Low
LM
part
icip
ation o
f
gro
up 5
5 to 6
4 y
ears
Develo
pin
g
main
ly thru
NG
Os
Short
age o
f
nurs
es in h
ospi-
tals
. N
o s
hort
-
age in the o
ther
secto
rs (
except
of qualif
ied
hom
e-h
elp
ers
,
but m
any s
er-
vic
es e
asily
recru
it u
nskill
ed
hom
e-h
elp
ers
).
Few
Larg
e c
ivil
org
s –
NG
Os
pro
vid
ing
many v
olu
n-
teers
.
Neig
hbours
very
im
port
ant
Yes b
ut no d
ata
1.
Yes
2. Y
es b
ut often
not ta
ken u
p
3.
Yes f
or volu
n-
teers
Germ
any
60%
55+
Unem
plo
yed / u
nskill
ed.
Civ
il serv
ants
, self e
mplo
yed
More
educate
d
in ft
em
plo
y-
ment. D
eclin
e in
norm
s o
n F
C.
Serv
ice led, not
needs led.
Short
ages, a lot
of overt
ime.
Yes –
much n
on
decla
red. Larg
e
variety
to m
eet
needs o
f house-
Yes.
Volu
n-
teers
com
-
pensate
d.
Est. 5
0,0
00 m
i-
gra
nts
as c
are
work
ers
, M
any
paid
thru
LT
CI
1. s
om
e -
fre
e
2. Y
es-
in a
ll
are
as
128
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
and s
ala
ried c
om
bin
e w
ork
with F
C,
M / c
accept re
sid
ential care
.
FC
s c
aring for
OP
not suff
er-
ing fro
m d
em
entia s
ignifi-
cantly m
ore
engaged in L
M
(30,9
%)
than those takin
g
care
of O
P s
uff
ering fro
m
dem
entia (
25,3
%).
LT
CI help
ed
wom
en r
etr
eat
from
FC
.
P25 –
diffe
r-
ences in a
tti-
tudes to F
C b
y
age g
roups.
(despite h
igh
unem
plo
ym
ent
rate
s)
Dra
matic p
rob-
lem
s, in
ade-
quate
pro
vis
ion,
20,0
00 n
ew
jobs
would
have to
be c
reate
d in
LT
C t
o fill
all
exis
ting a
nd n
ew
jobs a
nd to r
e-
duce the a
mount
of overt
ime.
27,0
00 u
nem
-
plo
yed. geriatr
ic
care
pro
fessio
n-
als
at F
edera
l
Labour
Offic
e;
quality
of appli-
cants
qualif
ica-
tions a
lso d
ete
-
riora
ting
hold
s. 1994 4
mill
. H
ousehold
s
em
plo
yed d
o-
mestic h
elp
but m
any s
till
illegal. P
rivate
household
s 2
nd
larg
est em
plo
yer
in g
rey L
M. W
ork
perm
its n
ow
perm
itte
d, un-
know
n take u
p
and a
void
ance
because o
f
hig
her
costs
for
soc. In
sura
nce.
3. Y
es
Gre
ece
Estim
ate
d 6
36,1
14 a
ged 6
0+
need p
art
or
full
tim
e c
are
.
No d
ata
on n
um
bers
of F
Cs.
Men incre
asin
gly
involv
ed a
s
FC
s
29%
of all
household
s c
are
for
som
eone w
ho is d
epend-
Attem
pts
to in-
cre
ase L
F p
ar-
ticip
ation o
f
wom
en-
but
curr
ently low
especia
lly for
old
er
wom
en
Low
pre
stige o
f
job a
nd g
ener-
ally low
pay
make m
any
decid
e that it is
not a d
esirable
labour
choic
e.
Som
e s
igns o
f
private
serv
ices
of nurs
es s
tart
-
ing for
the b
etter
off
.
Ort
hodox
Churc
h a
nd
oth
er
churc
hes r
un
volu
nta
ry
serv
ices that
inclu
de F
C
Yes-
many w
ork
-
ers
, 13%
esti-
mate
d in d
om
es-
tic w
ork
and
many o
f th
ese in
care
for
OP
-
rough e
stim
ate
1.
som
e
2.
som
e
3.
som
e
129
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
ent; this
inclu
des c
hild
ren,
the d
ependent dis
able
d a
s
well a
s d
ependent old
er
people
.
(45+
) plu
s h
igh
unem
plo
ym
ent.
Hig
h n
um
bers
cohabitin
g w
ith
OP
– a
s s
pouse
and c
hild, but
decline w
ith
incre
asin
g in-
com
e /
educa-
tion.
Overa
ll tr
adi-
tional lo
w n
um
-
bers
ente
ring
nurs
ing.
support
. O
r-
thodox h
ad
23,0
00 g
ivin
g
severa
l hours
of volu
nta
ry
work
per
year.
But lo
w levels
overa
ll of
volu
nta
rism
.
that
6.4
% o
f
Gre
ek h
ouse-
hold
s e
mplo
yed
som
eone to h
elp
OP
.
Hungary
O
f all
OP
- 11.3
% r
elied o
n
daughte
rs a
nd 8
.7%
sons.
Bro
thers
declined to 1
.5%
,
slight in
cre
ase in h
elp
by
sis
ters
4.1
% Incre
ase in n
os
of sons a
s c
are
rs b
ecause o
f
late
marr
iage.
Rura
l are
as a
doption o
f
young p
eople
(19.2
% O
P
rely
on friends)
and (
34.4
%)
neig
hbours
as F
Cs. S
pouse,
Ds a
nd s
ons m
ost im
port
FC
s.
Low
/ d
eclinin
g
LM
activity r
ate
for
wom
en –
huge incre
ase in
availabili
ty. Liv
e
less w
ith O
P.
Very
little p
t /
tim
e w
ork
No c
hanges in
am
ount of F
c
giv
en t
o O
P.
But
num
bers
of
po-
tential F
Cs
ste
adily d
eclines
for
OP
.
Inadequate
nurs
ing.
Short
ages o
f
work
ers
in p
ublic
secto
r, low
wages,
low
sta
tus. M
ain
ly
wom
en.
Hard
ly a
ny b
e-
cause o
f eco-
nom
ic s
ituation
of
OP
.
Availa
ble
and
as e
mplo
yees,
at lo
wer
wages than
public s
ecto
r.
Import
ant in
pro
vid
ing
serv
ices to
OP
.
Men a
s a
lter-
native to m
ili-
tary
serv
ice
Huge incre
ase
in c
ivil
org
ani-
zations-
70,0
00 N
GO
s,
13%
in h
ealth
and c
are
field
s.
No
1.
–
2. M
ost
have
train
ing.
Som
e innova-
tive t
rain
ing
from
NG
Os f
or
young p
eople
to b
ecom
e
care
rs. 90%
of
em
plo
yees o
f
NG
Os a
re
train
ed c
om
-
pare
d to 6
0–
70%
for
the
public s
ecto
r.
3. y
es-
som
e -
import
ant
Irela
nd
Huge incre
ase in L
M p
art
ici-
Dem
ogra
phic
4.6
% in n
urs
ing
Larg
e p
rivate
T
he v
olu
nta
ry
No s
tatistical
1.
Yes –
13 w
eek
130
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
pation o
f w
om
en to 5
0%
(2003)
and h
ighest ra
te o
f
incre
ase f
or
those a
ged 4
5-
64 y
rs. 1 / 3
work
ed p
art
tim
e.
38.6
% m
ale
, 61.4
%
fem
ale
(C
ensus 2
002)
Half F
C p
rovid
e c
are
for
pare
nts
/ in-law
; 1 in 4
for
spouse; 1in
5 a
noth
er
rela
-
tive.
5-6
% o
f adults a
s c
are
rs-
154,0
00-1
85,0
00 o
f w
hic
h
133,0
00 a
nd 1
59,0
00 a
dults
of w
ork
ing a
ge
In C
are
rs C
linic
s 4
3%
were
60+
22%
7-=
80
25%
men
bulg
e o
f people
aged 6
5+
will
be
in 2
040s.
Wom
en c
are
rs
have m
arg
inally
low
er
rate
s o
f
em
plo
ym
ent
(47.4
%)
as
wom
en n
ot car-
ing (
50.9
%).
Incre
ase in n
o.
of m
en c
are
rs.
Wom
en m
ay b
e
less w
illin
g to
care
in futu
re
with f
orm
al em
-
plo
ym
ent risin
g,
and g
reate
r
dem
and f
or
support
fro
m
govt., public
serv
ice. S
till
majo
rity
of
wom
en F
Cs n
ot
in p
aid
em
plo
y-
ment
No r
ela
tion b
e-
tween h
igher
education a
nd
hours
of
caring.
hom
e c
are
.
Gro
win
g d
e-
mand
Serv
ices g
ener-
ally u
nder-
funded a
nd u
n-
der-
sta
ffed e
s-
pecia
lly: nurs
ing
thera
pie
s c
hi-
ropody
respite c
om
mu-
nity / h
om
e-
based s
erv
ices
hom
e h
elp
Poor
pay a
nd
work
ing c
ondi-
tions f
or
hom
e
help
s a
nd n
o
pro
motion. H
H
not
attra
ctive t
o
work
with o
lder
people
. S
om
e
sta
ff s
hort
ages
secto
r – h
ospi-
tal, n
urs
ing
hom
e, th
era
pie
s,
hom
e n
urs
ing
am
ong o
thers
.
48%
of th
e
popula
tion a
vail
of care
as p
ri-
vate
patients
in
public h
ospitals
or
in p
rivate
hospitals
. S
om
e
sta
ff s
hort
ages
in p
rivate
secto
r
especia
lly n
urs
-
ing
secto
r is
a
sig
nific
ant
pro
vid
er
of
serv
ices in
com
munity,
prim
ary
, hos-
pital, long-s
tay
and r
espite
care
. T
he
HS
E f
unds
volu
nta
ry
org
anis
ations
to p
rovid
e
serv
ices it
cannot pro
-
vid
e its
elf.
Volu
nta
ry
org
anis
ations
are
som
e-
tim
es p
ro-
vid
ed thro
ugh
the r
elig
ious
org
anis
ations,
but m
any a
re
independent
and c
om
mu-
nity-b
ased.
data
availa
ble
,
anecdota
l evi-
dence o
f som
e
mig
rant w
om
en
work
ing in d
o-
mestic a
nd c
are
secto
rs
modula
r skill
s
train
ing in 1
7
locations
2.
Tra
inin
g p
ro-
vid
ed b
y v
olu
n-
tary
org
anis
a-
tions f
or
hom
e
care
pers
on-
nel. W
hile r
ec-
om
mendations
have b
een
made r
egard
-
ing c
ert
ific
ation
of hom
e h
elp
s,
these r
ecom
-
mendations
have n
ot yet
been im
ple
-
mente
d b
y
Govern
ment.
3.
–
131
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
Italy
75-8
0%
of eld
erly c
are
is
carr
ied o
ut in
the info
rmal
netw
ork
of
an e
xte
nded fam
-
ily Incre
ase in F
C a
ge (
61
men, 60 w
om
en),
in n
os o
f
sons c
aring b
ut 2 / 3
wom
en
are
the F
Cs r
isin
g to 8
1%
for
heavy c
are
. 10%
are
over
80
years
Decline in m
ulti-genera
tion
household
s.
Care
rs h
ave m
ore
incom
e
than n
on c
are
rs. 60%
not
happy w
ith e
conom
ic s
itua-
tion. W
ork
ing w
om
en g
ive
less t
ime t
o c
are
. C
are
rs
have a
hig
her
education
level th
an n
on c
are
rs
Decline b
ecause
of in
cre
ase in
num
bers
of
wom
en in L
M
(20%
in 1
970 to
36%
IN
2003)
and incre
ase in
retire
ment age.
Local la
bour
supply
of hom
e
care
work
ers
for
OP
much low
er
than the d
e-
mand, sin
ce
local people
unw
illin
g to a
c-
cept a job that is
consid
ere
d tirin
g
and w
earing.
Tre
nd o
f S
tate
in
pro
vid
ing m
ore
cash n
ot ser-
vic
es. (u
sed b
y
care
rs to p
ur-
chase in p
rivate
serv
ices)
756,4
46 c
are
allow
ances w
ere
gra
nte
d to Ita
lian
citiz
ens o
f over
65 y
ears
of
age,
for
a t
ota
l cost
of
3,6
22,3
22,9
40 €
600-7
00,0
00,
50%
of to
tal
regis
tere
d w
ork
-
ers
are
fore
ign-
ers
. U
sed f
or
hom
e a
nd n
ight
care
, used in
private
hospi-
tals
. A
nd p
ublic
for
nig
ht care
“badanti”
(pri-
vate
ly p
aid
car-
ers
A n
um
ber
of
self h
elp
and
advocacy
gro
ups a
nd
active in s
om
e
are
as.
(ww
w.a
imaro
ma.it)
Attitude o
f lo
cal
work
forc
e h
as
incre
ased r
e-
cours
e to f
ore
ign
work
ers
who, at
least during the
firs
t period o
f
their s
tay in Ita
ly,
more
ready to
work
in o
ccupa-
tional secto
rs
that are
chara
c-
terized b
y g
reat
uncert
ain
ty a
nd
are
consid
ere
d
menia
l by the
locals
Thus a
larg
e a
nd g
row
-
ing n
um
ber;
many ille
gal.
Incre
asin
g e
ffort
s
to legalise them
.
1. –
2. Y
es f
or
those
em
plo
yed in
form
al in
stitu
-
tions a
nd s
er-
vic
es.
But fe
w
mig
rants
–
94%
have
train
ing
(though o
ften
educate
d
hig
hly
. 36%
of
fam
ilies’ per-
sonal assis
-
tants
(36%
)
and 1
6%
of
em
plo
yed
hom
e c
are
work
ers
have
none o
r a just
suffic
ient un-
ders
tandin
g o
f
the Ita
lian lan-
guage
3.
Luxem
-
bourg
465 F
Cs r
ecord
ed a
s g
ivin
g
help
to fam
ily m
em
ber-
94.2
% f
em
ale
. – m
ean a
ge
43.7
- M
ostly s
erv
ing p
eople
aged 7
0+
(80%
)
O
vera
ll no c
ur-
rent short
ages
sin
ce w
ages a
re
hig
h a
nd a
ttra
ct
work
ers
fro
m
Som
e b
egin
nin
g
to e
merg
e
M
ore
than h
alf in
health a
nd s
ocia
l
serv
ices a
re o
f
fore
ign o
rigin
(main
ly o
ther
EU
–
132
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
neig
hbouring
countr
ies; but
long term
fear
of
short
ages in
nurs
ing p
ers
on-
nel evid
enced
by d
eclin
e in
enro
lment in
Nurs
ing S
chool.
countr
ies)
Malta
Of
the 2
59 f
am
ily c
are
rs
benefiting f
rom
the G
overn
-
ment’s C
are
r’s P
ensio
n 5
9%
cent
were
fem
ale
s a
s c
om
-
pare
d to 4
1%
men. A
noth
er
stu
dy h
ad 7
4%
of F
Cs fe-
male
.
74.5
% o
f in
terv
iew
ed F
Cs
were
child F
Cs.
78.7
% r
espondents
in o
ne
researc
h c
ohabitant w
ith O
P.
18.1
per
cent liv
ed b
etw
een
1-2
kilo
metr
es a
way.
Low
(31%
) LM
part
icip
ation
of w
om
en 1
6-6
4.
Som
e e
vid
ence o
f in
cre
asin
g
male
part
icip
ation in F
C
Decline b
ecause
of in
cre
ases in
num
bers
of
OP
,
resid
ential m
o-
bili
ty a
nd in-
cre
asin
g L
M
part
icip
ation o
f
wom
en.
But m
ore
OP
involv
ed in c
are
of gra
ndchild
ren
Decline in n
um
-
bers
ente
ring
religio
us v
oca-
tions (
nuns)
has
led to incre
asin
g
reliance o
n p
aid
lay w
ork
ers
.
How
ever
no
difficultie
s in
recru
itm
ent fo
r
part
tim
e c
are
work
ers
.
How
ever
no
difficultie
s in
recru
itm
ent fo
r
part
tim
e c
are
work
ers
.
A lot
of
work
thru
Churc
h
with e
lderly
Good
Neig
hbour
Schem
e;
So-
cia
l C
lubs;
Self-H
ealth
Care
; A
ware
-
ness P
ro-
gra
mm
es
in S
chools
No
1.
Yes
2.
Yes-
availa
ble
but
not
com
-
puls
ory
in p
ri-
vate
secto
r.
3.
The v
olu
nte
ers
of each g
roup,
85 p
er
cent of
whom
are
them
selv
es
eld
erly, re
ceiv
e
train
ing g
iven
by C
arita
s s
o-
cia
l w
ork
ers
at
the h
eadquar-
ters
. T
hey a
lso
attend r
e-
fresher
sem
i-
nars
org
anis
ed
every
3
month
s.
133
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
Neth
er-
lands
no n
ation-w
ide r
egis
tration o
f
FC
s.
3,7
mill
ion –
29%
of D
utc
h
popula
tion o
ver
18 y
ears
–
pro
vid
ed c
are
for
a r
ela
tive,
frie
nd o
r neig
hbour
in n
eed
in 2
001. M
ore
than tw
o m
il-
lion p
eople
took c
are
of
som
eone 6
4 +
years
.
400,0
00 (
18.8
%)
inte
nse a
nd
long term
.
Age b
reakdow
n o
f F
c s
how
more
aged 5
4%
= a
ged 4
5-
64
The p
refe
rence for
help
fro
m
rela
tives / a
cquain
tances h
as
declined e
specia
lly a
mong
hig
her
educate
d p
eople
.
They m
ore
often c
all
for
as-
sis
tance f
rom
private
care
-
giv
ers
71%
of F
Cs
aged18-6
5
years
, of w
hom
60%
active a
t
the L
M-s
et to
incre
ase.
Som
e c
are
leave. B
ein
g
develo
ped w
ork
leaves:.
FC
s s
am
e r
ate
s
of em
plo
ym
ent
as the g
enera
l
popula
tion (
64%
of th
e p
eople
betw
een 1
8 a
nd
65 y
ears
), a
nd
sam
e e
ducation
level. F
Cs,
who
work
fullt
ime
pro
vid
e less
hours
per
week
than F
Cs w
ith a
part
-tim
e job o
r
without a job.
Incre
ase o
f fe
-
male
L.M
. par-
ticip
ation, m
igra
-
tion a
way fro
m
Yes-
volu
n-
teers
als
o
funded b
y
govt.
Low
- 4
.15 –
6%
% o
f th
e m
igra
nt
popula
tion in
nurs
ing a
nd c
ar-
ing jobs.
The
gre
ate
st im
pedi-
ment fo
r ente
ring
this
part
of th
e
LM
is r
equire-
ment fo
r hig
her
education a
nd
poor
com
mand o
f
the D
utc
h lan-
guage.
1. y
es
2
Yes –
but not
for lo
wer
levels
tho’ opport
uni-
ties f
or
on the
job tra
inin
g e
x-
ist.
134
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
pare
nts
) and
agein
g o
f F
Cs
affect tr
ends in
FC
. gro
win
g
tendency that
more
people
may c
hoose n
ot
to c
are
.
Norw
ay
5%
respondents
16-7
4 g
ave
som
e c
are
/ h
elp
to a
dults in
ow
n h
ousehold
in 2
000 (
due
to o
ld a
ge, dis
abili
ty o
r ill
-
ness).
= 1
60,0
00 p
eople
. 8%
- or
appro
xim
ate
ly 2
55,0
00
people
- h
elp
ed p
eople
in
oth
er
household
s. C
are
/
help
giv
en b
y p
eople
aged
75+
not in
clu
ded. T
ota
l in
-
form
al care
receiv
ed b
y p
eo-
ple
aged 6
7+
fro
m p
eople
in
ow
n a
s w
ell a
s o
ther
house-
hold
s, am
ounte
d to 4
9,0
00
man y
ears
. W
om
en g
ive 2
.5
tim
es a
s m
uch f
am
ily c
are
as
men. T
he g
ender
diffe
rence
is a
t its s
malle
st fo
r th
e o
ld-
est care
giv
ers
The p
roport
ion
of th
e p
opula
tion
aged 1
6-7
4 g
iv-
ing f
am
ily c
are
as w
ell a
s tim
e
spent on f
am
ily
care
has b
een
som
ew
hat re
-
duced f
rom
1990 to 2
000
people
in low
incom
e h
ouse-
hold
s m
ore
often
giv
e h
elp
to
oth
er
house-
hold
s than d
o
mem
bers
of
better-
off
household
s. B
ut
overa
ll F
C h
as
not been r
e-
duced, but has
rath
er
in-
Short
ages e
sp.
in u
rban a
reas-
hig
h turn
over
Som
e a
re d
e-
velo
pin
g
Yes-
both
info
rmal
(neig
hbours
and f
riends)
and f
orm
al in
NG
Os.
Legal m
igra
nts
import
ant un-
skill
ed c
are
work
ers
. A
lso
legally
and ille-
gally in p
rivate
hom
es. M
ain
ly
housew
ork
and
to a
very
sm
all
exte
nt care
work
for
the e
lderly.
1.
Som
e
2.
yes-
but not all
em
plo
yees
train
ed
3.
yes
135
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
cre
ased, in
the
last 30 y
ears
Pola
nd
FC
- daughte
r 37.1
%),
spouse (
29.2
%),
son
(20.9
%),
gra
ndchild
ren
(15.5
%),
92%
of O
P b
elie
ve
that in
case o
f sic
kness they
can c
ount on h
elp
fro
m their
fam
ilies
No s
pecia
l
leave. A
bout 1.3
work
and c
are
.
Pro
ble
m o
f un-
em
plo
ym
ent
am
ongst young
makes t
hem
unable
to h
elp
financia
lly.
No p
roble
m
because o
f hig
h
rate
s o
f unem
-
plo
ym
ent. B
ut
low
wages a
nd
mig
ration to
oth
er
EU
coun-
trie
s m
ay h
ave
knock o
n e
f-
fects
. P
lus f
i-
nancia
l pro
b-
lem
s m
ean less
people
hired
than n
eeded.
Ditto
– a
ll le
vels
can b
e e
m-
plo
yed
Yes –
Maltese
Associa
tion
help
ed s
tart
up a
no o
f
NG
Os.
Used in h
os-
pic
es
Very
few
for
bet-
ter
off fro
m B
ye-
loru
ssia
.
1. n
o-
very
rare
-
Alz
heim
er
gro
ups
2.
Yes f
or
sta
te
instits
. – n
ot
alw
ays in p
rac-
tice, N
ot in
pri-
vate
hom
es.
3. Y
es -
som
e
Port
ugal
Est. 2
.3%
of
pop.
care
s f
or
OP
main
ly w
om
en -
25%
of
FC
s a
re m
ale
.
Even w
hen h
ousekeeper
em
plo
yed, F
C p
ays. superv
i-
sio
n, m
anagem
ent, e
mo-
tional support
, tr
ansport
and
financia
l m
anagem
ent.
Hig
h r
ate
of
fem
ale
em
plo
y-
ment – 6
1.2
%
No p
roble
m. B
ut
pro
ble
m o
f lo
w
earn
ings –
lim
it
choic
e a
vailable
and the n
um
-
bers
recru
ited
No –
low
earn
-
ings.
Few
of th
e
50,0
00 w
ork
with O
P –
not
attra
ctive for
volu
nte
ers
.
Info
rmal sup-
port
fro
m
neig
hbours
/
frie
nds. som
e
local parish
support
thru
’
Cath
olic
Churc
h.
No o
ffic
ial data
.
Influx f
rom
E.E
uro
pe,
Ex
Port
uguese c
olo
-
nie
s c
heaper
and
hig
her
level of
qualif
ication e
sp.
wom
en a
s
housekeepers
.
Mediu
m a
nd
above incom
e
gro
ups u
se
housekeepers
–
main
ly less inti-
mate
care
of
OP
.
1.
No
2. H
eads o
f in
sti-
tutions a
nd
serv
ices a
re
qualif
ied, not
oth
ers
.
E.E
uro
peans
often m
ore
educate
d than
locals
of oth
er
mig
rants
.
3.
–
136
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
Legalised a
s
dom
estic e
m-
plo
yees.
Slo
venia
F
Cs
caring for 30-4
0,0
00
(10%
of O
P) (e
xclu
din
g those
in inst
itutions)
Daughte
rs, w
ho
were
most
fre
quently in touch
with their p
are
nts
, belo
nged to
the 3
3 to 5
5-y
ear age g
roup
and s
ons
most
ly to the 4
0 to
49-y
ear
age g
roup. It h
as
als
o
been reveale
d that si
sters
,
fem
ale
pensi
oners
, are
als
o
an im
portant part o
f th
e info
r-
mal n
etw
ork
of th
e e
lderly
Hig
h r
ate
s o
f
fem
ale
em
plo
y-
ment but in
90s
many a
t 50+
offere
d e
arly
retire
ment on full
pensi
on –
whic
h
is n
o longer pos-
sible
and w
ill
incre
ase s
train
on F
Cs
who
work
. A
ct
Am
endin
g the
Socia
l S
ecurity
Act not yet im
-
ple
mente
d b
ut
adopte
d, allo
ws
for F
Cs
to b
e
regis
tere
d a
s
‘fam
ily a
ssis
-
tants
’.
socia
l care
rs
num
bers
dro
p-
pin
g d
ue to insuf-
ficie
nt fu
nds
to
enable
additio
nal
recru
itm
ent.
Availa
ble
Y
es-
gro
wth
in
org
aniz
ations
pro
vid
ing
volu
nte
er
support
e.g
.
Red C
ross,
Carita
s.
Not applic
able
1.
som
e
2.
som
e
3.
som
e
Spain
12.4
% h
ousehold
s c
onta
in a
FC
for
the e
lderly. i.e., a
l-
most 5%
of people
over
18
giv
e info
rmal help
to a
n O
P
appro
xim
ate
tota
l of
75%
of O
P h
ave
more
than o
ne
child a
live (
av.
No n
early 3
).
Alm
ost
24%
No info
rmation
Few
em
erg
ing
private
org
an-
ized s
erv
ices.
Contr
acting
private
care
Very
sm
all
part
icip
ation
of volu
nte
ers
or
the c
hurc
h
in c
aring for
Imm
igra
nts
,
main
ly illegal,
import
ant-
, out-
sid
e h
elp
is
sought fo
r a few
1.
Som
e
2.
Yes-
full
cert
i-
fication
3.
som
e e
.g. fo
r
Alz
heim
er,
137
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
1,4
64,2
99 p
eople
, of w
hic
h
83%
are
wom
en m
ain
ly 4
5-
64 o
f lo
w level education a
nd
housew
ife. 22%
em
plo
yed
(36%
part
tim
e w
ork
64%
full
tim
e. 28%
of th
e p
opula
tion
identifies a
n e
lderly p
ers
on in
their fam
ily in n
eed o
f care
and s
pecia
l attention, and
alm
ost
21%
cla
ssify t
hem
-
selv
es a
s c
are
rs t
o s
om
e
exte
nt.
FC
s-
spouse 1
2.4
%, daugh-
ter
26%
, son 1
5%
, sis
ter
1.4
%, bro
ther
0.4
%, gra
nd-
daughte
r 8%
, gra
ndson
5.4
%, daughte
r-in
-law
5.6
%,
son-in-law
6%
oth
er
rela
tives
14%
, neig
hbours
and / o
r
care
takers
5.6
%, fr
iends 4
%,
household
em
plo
yees u
nder
1%
.
share
a h
om
e
with s
om
e c
hild
and 4
3.5
% liv
e
in the s
am
e
tow
n, B
ut gen-
era
tional and
L.M
. changes
especia
lly for
wom
en, th
ere
is
a feelin
g o
f un-
cert
ain
ty a
mong
curr
ent care
rs.
They p
erc
eiv
e a
lack o
f re
cip
roc-
ity w
ith r
espect
to the c
om
ing
genera
tions o
f
care
rs, and u
n-
cert
ain
ty a
s
regard
s the f
u-
ture
of th
ose
receiv
ing c
are
.
Esp.
acute
am
ong the o
lder
care
rs a
nd those
that are
more
alo
ne
12%
of F
Cs
sto
pped w
ork
to
deal w
ith c
aring-
Wom
en w
ithout
associa
ted w
ith
livin
g a
lone
(4X
< c
hances
of contr
acting it;
absence o
f chil-
dre
n.
OP
with
hig
h incom
e a
nd
education leads
to h
igher
use o
f
private
serv
ice
the e
lderly
(0.1
%),
hours
, but w
ith
incre
asin
g d
e-
pendency s
tays
in the h
om
e o
f
OP
Rem
ain
in t
his
work
until th
eir
situation is legal-
ised.
Pro
ble
ms:
excessiv
e w
ork
-
ing d
ays, dom
es-
tic a
ctivitie
s b
e-
yond c
aring for
the p
ers
on, lo
w
wages, ill
egal
situation. B
al-
ance is g
enera
lly
positiv
e f
or
the
fam
ilies a
nd for
the im
mig
rant
care
rs. B
oth
positiv
ely
valu
e
the a
ffective r
ela
-
tionship
s they
esta
blish w
ith the
OP
.
som
e R
egio
ns.
138
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
stu
die
s o
r w
ith
prim
ary
educa-
tion h
ave a
gre
ate
r pro
pen-
sity t
o g
ive u
p
paid
work
.
Sw
eden
“Redis
covery
” of F
C e
.g.
CA
RE
R 3
00 p
roje
ct
1. In
cre
asin
g%
OP
rely
ing o
n
FC
+ / -
serv
ices, and d
eclin
-
ing%
rely
ing o
n p
ublic
ser-
vic
es+
/ -
FC
2. > 8
0%
fem
ale
LF
part
ici-
pation. (h
ighest in
EU
)
The inte
gra
tion
of care
r support
into
the f
orm
al
serv
ice c
are
managem
ent
syste
m.
Care
work
ers
(at
all
levels
inclu
d-
ing p
hysic
ians)
majo
r pro
ble
ms
in r
ecru
itm
ent
and r
ete
ntion,
many u
ntr
ain
ed
and leavin
g L
M
(early r
etire
ment
and s
ick leave)
A h
igh s
erv
ice
syste
m f
ocusin
g
on h
om
e c
are
rath
er
than insti-
tutional.
2 /
3 O
P liv
e
alo
ne.
Public
/ p
rivate
mix
but private
is n
ot out-
of-
pocket pay-
ments
Volu
nta
ry
org
s. D
on’t
pro
vid
e h
ands
on c
are
, but
much info
rmal
volu
nte
er
help
to O
P –
3 n
at.
care
rs O
rgs
with p
ublic
fundin
g
No d
ata
1. Y
es –
fro
m
subsid
ized c
ar-
ers
’ gro
ups
2.
Yes –
in s
er-
vic
e –
only
half
of 180,0
00
work
ers
are
train
ed in
low
er
levels
.
3. Y
es-
sit in
serv
ices
Sw
itzer-
land
23.1
% o
f popula
tion a
ged
15+
have b
een c
aring -
with-
out paym
ent - fo
r a p
ers
on
aged 6
5+
in the y
ear
prior
to
surv
ey =
1.3
6 m
ill p
ers
ons.
Pre
-retire
d a
ctive p
op. 50-5
9
years
(36.9
%)
and y
oung
retire
es 6
0-6
9 y
ears
(35.1
%)
pro
vid
e m
ore
care
than o
ther
age g
roups. m
ore
than 1
out
Few
measure
s
yet in
pla
ce to
support
work
ing
FC
s. U
rban /
rura
l and c
anto
n
diffe
rences. M
en
aged 5
0-5
9 a
nd
60-6
9 y
ears
old
in e
qual pro
por-
tions a
s F
Cs
Short
ages o
f
work
ers
and
mig
rants
re-
cru
ited to w
ork
in g
eriatr
ic insti-
tutions a
nd s
er-
vic
es.
Yes, especia
lly
wom
en f
or
do-
mestic w
ork
. N
o
data
, curr
ently
bein
g s
tudie
d.
Main
ly fro
m S
.
Euro
pe a
nd L
atin
Am
erica.
–
139
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
of 4 o
lder
retire
es a
ged 7
0-
79 y
ears
old
(26.3
%)
and o
f
40-4
9 y
ears
old
(25.9
%)
pro
vid
e c
are
to a
noth
er
re-
tire
e.
F / T
paid
work
-
ers
, stu
dents
and d
isable
d
retire
es r
eport
giv
ing less c
are
(still
11.9
- 19.4
%
of
FC
s).
33%
of
retire
d, part
tim
e
work
ers
, w
ork
-
ing in t
he fam
ily
com
pany o
r at
hom
e r
eport
caring f
or
an
OP
. 21.8
% u
n-
em
plo
yed r
eport
pro
vid
ing c
are
.
UK
16%
over
the a
ge o
f 16 a
re
curr
ently c
are
rs; 1 in 5
household
s c
onta
in a
care
r.=
6.8
mill
ion p
eople
in 5
mill
ion
household
s R
egio
nal varia-
tions e
.g. N
ort
h E
ast (2
0%
)
low
est in
London (
11%
), 1
8-
19%
in N
.W., S
.W. and
Wale
s. P
eak o
f 24%
at age
45-6
4, decre
ases to 1
6%
aged 6
5+
. F
C w
om
en 1
8%
V
14%
men, no g
ender
varia-
tions in the p
roport
ions o
f
men a
nd w
om
en w
ho a
re c
o-
resid
ent care
rs. W
om
en
None identified
Recru
itm
ent and
rete
ntion a
ma-
jor
issue w
ith
respect to
both
qualif
ied a
nd
unqualif
ied s
taff.
In the form
er
casew
ork
with
old
er
people
is
not accord
ed the
valu
e a
nd s
tatu
s
of acute
care
.
With r
espect
to
unqualif
ied s
taff,
turn
over
is h
igh
See p
ublic s
ec-
tor-
sam
e.
Larg
e v
olu
n-
tary
secto
r –
many s
elf h
elp
FC
gro
ups
No d
ata
on ille
gal
mig
ration.
Mig
rants
re-
cru
ited a
nd d
is-
pro
port
ionate
ly
em
plo
yed in
health a
nd s
ocia
l
serv
ices.
1.
Yes-
St. J
ohn’s
Am
bula
nce-
pro
vid
e c
ert
ifi-
cation
2.
NV
Q q
ualif
ica-
tions f
or
form
al
but not quali-
fied p
rofe
s-
sio
nal care
rs.
Form
al pro
fes-
sio
nal care
rs
are
fully
quali-
fied a
nd r
egis
-
tere
d.
140
Co
un
try
Fam
ily c
are
rs
Tre
nd
s in
availab
ilit
y o
f
FC
Co
mb
inin
g
wo
rk a
nd
care
Pu
blic s
er-
vic
es,
lab
ou
r
su
pp
ly a
nd
tren
ds
Pri
vate
serv
ices
Vo
lun
teers
M
igra
nt
care
rs
Tra
inin
g
1.
fam
ily c
are
rs
2.
form
al care
rs
3.
vo
lun
teers
more
lik
ely
to c
are
for
som
e-
one in a
noth
er
household
(12%
/ 9
%);
to b
e the m
ain
support
er
wheth
er
in the
sam
e (
35%
/ 3
0%
) or
an-
oth
er
household
(25%
/
19%
); a
nd to p
rovid
e 2
0
hours
or
more
care
per
week
(29%
/ 2
6%
).
52%
are
lookin
g a
fter
a p
ar-
ent or
pare
nt-
on-law
, 16%
are
caring for
a s
pouse, and
8%
for
a c
hild
One third o
f
care
rs c
o-r
esid
e w
ith the
pers
on they a
re c
aring for,
while tw
o thirds liv
e in a
n-
oth
er
household
. C
o-r
esid
ent
care
rs a
re m
ore
lik
ely
to b
e
spendin
g 2
0 h
ours
a w
eek o
r
longer
pro
vid
ing c
are
(63%
/
11%
). S
pouses a
re m
ajo
rity
of co-r
esid
ent F
Cs e
specia
lly
75+
.
and w
ages low
,
furt
her
exacer-
bating a
n a
l-
ready d
ifficult
situation
3.
Yes
141
5.1
0
An
nex 1
0 –
Ma
trix
: O
ther
Iss
ue
s
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
Austr
ia
69%
FC
said
physi-
cal burd
ens; 79%
psycholo
gic
al bur-
dens; socia
l is
ola
-
tion s
evere
pro
ble
m
–
Pensio
ners
’ org
ani-
zations a
ffili
ate
d to
polit
ical part
ies.
Um
bre
lla o
rganiz
a-
tion
- Low
IT
usage b
y
OP
. M
edic
al ale
rt o
r
ala
rm s
yste
ms a
s a
pers
onal em
erg
ency
response s
yste
m
but fe
w c
overe
d -
0.2
% o
f all
people
aged 6
5 y
ears
or
over.
72%
of F
C felt
transfe
rs w
ere
im
-
port
ant. A
nd o
nly
28%
felt that in
heri-
tance p
lays "
a n
eg-
ligib
le r
ole
” in
inte
r-
genera
tional re
la-
tions.
Belg
ium
1998 s
ettin
g u
p o
f
Centr
al R
eport
Poin
t
for
Eld
erly A
buse
and C
entr
e for
help
for m
istr
eate
d e
ld-
erly p
eople
)
Yes,
import
ant.
2002-3
20%
men,
9%
wom
en 6
5-7
4
used IT
(9%
M, 2%
W Inte
rnet)
ww
w.s
enio
rweb.b
e
pro
vid
es info
rma-
tion, org
aniz
es
com
pute
r cours
es
for
eld
erly p
eople
and inte
rnet panel
dis
cussio
ns o
n top-
ics that concern
OP
and F
Cs.
No r
ole
Bulg
aria
No d
ata
-
-
-
Yes p
lay a
part
.
Sta
te inte
rvenes if
fam
ily take p
ropert
y
of O
p a
nd then d
o
not pro
vid
e c
are
.
Czech R
epublic
Only
a few
, but sev-
era
l str
ong N
GO
s o
f
- S
om
e h
om
e a
larm
syste
ms o
pera
ted
Not le
gally
142
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
O
P w
ho p
rovid
e
som
e s
erv
ices t
hat
als
o h
elp
FC
s. A
lz-
heim
er
Associa
tion
an e
xception
by Z
ivot 90 a
nd the
Centr
e o
f G
ero
nto
l-
ogy. C
zech A
lz-
heim
er
Socie
ty h
as
data
base o
f ser-
vic
es s
ee
ww
w.g
ero
nto
logie
.c
z
Denm
ark
1 s
mall
stu
dy
show
ed F
Cs e
sp.
agein
g s
pouses
pro
vid
ing c
are
and
support
are
con-
cern
ed a
bout th
eir
ow
n h
ealth a
nd
well-b
ein
g a
nd
worr
y a
bout w
hat
would
happen if
they c
ould
no longer
care
for
the s
pouse.
No d
ata
-
Yes o
ne to s
upport
coopera
tion b
e-
tween F
Cs a
nd
pro
fessio
nals
.
ww
w.p
gru
ppen.d
k -
Rela
tives o
f F
rail
Old
er
People
but
oth
er
NG
Os (
2)
als
o
support
OP
and
FC
s
less than 1
% in 1
stu
dy g
ot help
fro
m
fam
ily m
em
bers
or
oth
er
mem
bers
of
socia
l netw
ork
s w
ith
pers
onal care
that
less than 5
% a
ged
60-7
5 y
ears
liv
e
with c
hild
ren. LA
obliged to p
rovid
e
respite h
elp
to
spouses, pare
nts
or
oth
er
clo
se r
ela
tives
caring for
a p
hysi-
cally
or
menta
lly
dis
able
d p
ers
on.
U
nlikely
Fin
land
- A
bsence o
f data
3 m
ain
gro
ups –
larg
est national
wid
e, bi-lingual.
Funded b
y s
lot m
a-
chin
es A
ssocia
tion.
1 focuses o
n c
are
-
giv
ers
1 / 3
60+
get som
e
help
Yes g
ero
technolo
gy
e.g
. lo
com
otion
devic
es in / o
ut of
house, eating,
sle
epin
g, security
e.g
. tim
ers
for lights
,
locom
otion r
ecogni-
tion, security
tele
-
phone, doorb
ell
No.
Incre
ase in O
P liv
-
ing a
lone. 60%
of
75+
liv
e in 1
pers
on
household
s.
143
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
ala
rm. F
or
FC
nig
h
ala
rm-
wakes F
C u
p
if O
P m
oves f
rom
bed in n
ight.,
Fra
nce
Ris
ks o
f depre
ssio
n
is tw
ice h
igher
Am
ongst F
Cs than
in the g
enera
l popu-
lation.
Debate
on m
al-
treatm
ent and
abuse o
f O
P in insti-
tutions a
nd
at hom
e b
y info
rmal
and p
rofe
ssio
nal
care
rs
2-
but not very
str
ong in term
s o
f
impact.
No d
ata
.
Old
pare
nts
- 5
0%
have 1
child
nearb
y
(less 1
km
.), and
90%
a c
hild
liv
-
ing <
50 k
m; 31%
are
liv
ing in the
sam
e v
illage o
r
tow
n a
nd 6
7%
in the
sam
e D
epart
.
Yes, but no d
ata
e.g
. use >
mobile
phones a
nd Inte
rnet
by 5
0+
. W
ebsites
on s
ocio
-
gero
nto
logy w
ith
info
and a
dvic
e f
or
FC
s.
New
technolo
gie
s
have a
n indirect
impact on F
Cs-
thru
ala
rms
Pro
bably
but no
data
/ r
esearc
h
Germ
any
Stu
dy o
f 1911 F
Cs-
those w
ho s
pend
larg
e a
mounts
of
tim
e r
eport
ed p
hysi-
cal com
pla
ints
such
as e
xhaustion, pain
in a
rms a
nd legs,
heart
tro
uble
and
severe
sto
mach
pain
more
than f
or
genera
l popula
tion.
sym
pto
ms m
ore
pro
nounced in F
Cs
of cognitiv
ely
im
-
paired p
ers
ons
10,8
% (
n=
46)
re-
port
ed v
iole
nce,
where
as p
sycho-
logic
al m
altre
atm
ent
and fin
ancia
l dam
-
age w
ere
report
ed
more
fre
quently. -
rela
ted to >
need for
support
and c
are
+
a d
eclin
e o
f physic
al
str
ength
. D
om
estic
vio
lence h
idden.
OW
more
often the
vic
tim
s o
f dom
estic
abuse B
ut
FC
s a
ct-
ing v
iole
ntly t
ow
ard
s
their O
P o
nly
22%
2 m
ajo
r F
ounda-
tions a
nd m
any
NG
Os, pre
ssure
gro
ups a
nd F
C
gro
ups b
ut 6%
regu-
larly v
isit c
off
ee-
gro
ups f
or
FC
s o
r
counsellin
g h
ours
.
2%
meet in
private
self-h
elp
gro
ups a
nd
3%
regula
rly m
eet
in g
roups f
or fa
mily
care
rs w
ith p
rofe
s-
sio
nal counselli
ng.
Only
about 16%
of
all
FC
s r
egula
rly
and 3
7%
occasio
n-
62%
of O
P liv
e in
the s
am
e h
ousehold
with F
C, 8%
FC
s
live in t
he s
am
e
house o
r very
nearb
y, about 14%
live less than 1
0
min
ute
s a
way,
about 8%
liv
e m
ore
than 1
0 m
inute
s
aw
ay, re
main
ing 8
%
of O
P in n
eed o
f
care
no r
egula
r
fam
ily c
are
-giv
ing o
r
support
.
Am
ongst te
rmin
ally
Yes g
ero
technolo
gy
pro
mote
d in L
A
cente
rs o
r charita
ble
org
anis
ations a
nd
the g
ero
technolo
gi-
cal in
dustr
y p
ro-
vid
es the e
xhib
its
mostly f
or fr
ee b
e-
cause there
is a
gre
at in
tere
st in
sellin
g n
ew
tech-
nolo
gie
s e
.g.
"Skala
-mobile
s",
com
ple
te b
arr
ier-
free f
urn
ishin
g,
em
erg
ency-c
alls
,
adapting s
anitary
Yes im
port
ant-
stu
dy s
how
ed that
42%
people
be-
lieved s
ocia
l-
norm
ative o
blig
a-
tions f
or
FC
-giv
ing
is p
ure
ly a
ltru
istic.
Mora
l obligations
and fin
ancia
l con-
sid
era
tions a
re n
ot
mutu
ally
exclu
siv
e.
144
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
of all
report
ed c
ases
of abuse a
gain
st
OP
. A
lso u
nknow
n
no.
of
cases o
f
abuse o
f O
P a
gain
st
FC
s.
ally
take u
p c
oun-
sellin
g a
nd a
dvic
e.
ill >
81%
FC
s w
ere
fem
ale
: w
ives,
daughte
rs o
r daugh-
ters
in law
. 32%
of
these F
Cs w
ere
als
o in p
aid
em
-
plo
ym
ent and for
daughte
rs p
ropor-
tion w
as 6
1%
!; 8
7%
of th
em
additio
nally
were
responsib
le for
their o
wn h
ousehold
environm
ent or
sev-
era
l applia
nces in
ord
er
to b
ala
nce
functional handi-
caps o
r im
pair-
ments
.
Gre
ece
No d
ata
. S
mall
old
qualita
tive s
tudy o
f
24 F
Cs, 8 h
ad b
ad
health, 11 d
ete
rio-
rating h
ealth. 7
clin
ical depre
ssio
n.
Only
3 n
o p
sycho-
logic
al pro
ble
ms.
50%
mentioned
positiv
e a
spects
of
care
.
data
fro
m 1
989 –
know
n f
inancia
l and
em
otional abuse in
som
e c
ases
Virtu
ally
no g
enera
l
care
rs’ gro
ups a
nd
no r
epre
senta
tion a
t
national le
vel. E
xis
t-
ing o
nes a
re for
care
rs o
f th
ose w
ith
Alz
heim
er-
over
20
of th
ese.
No d
ata
. 42%
of all
FC
s a
ssess t
o b
e
rath
er
heavy a
nd
41%
of
FC
s e
x-
trem
ely
physic
ally
and m
enta
lly b
ur-
dened a
nd o
nly
7%
assessed n
o to b
e
burd
ened
mobile tele
phone
has h
elp
ed c
om
mu-
nic
ations b
etw
een
FC
and O
P. Low
rate
s o
f In
tern
et
connection a
mongst
OP
.
Yes-
recip
rocity
import
ant. P
ropert
y
often tra
nsf
err
ed a
t
marr
iage o
f chil-
dre
n, w
ith p
are
nts
havin
g u
sage.
Hungary
30-5
0%
of people
in
the 7
0-7
9 y
ears
age
gro
up, and m
aj of
OP
> 8
0 y
ears
need
help
in d
ay-t
o-d
ay
activitie
s
No d
ata
. P
re 1
990
the p
ractice o
f con-
tracts
for
support
gave o
pport
unitie
s
for
abuse a
gain
st
the e
lderly. T
oday
one o
f th
e g
reate
st
pro
ble
ms is r
obbery
of th
e e
lderly.
The larg
e N
GO
s
work
to s
upport
and
train
FC
s.
80%
of O
P c
ounte
d
on F
C in o
ffic
ial
affairs, household
tasks a
nd n
urs
ing.
Few
er
can c
ount on
financia
l help
Ala
rm b
ell
syste
ms
– low
tech b
ut af-
ford
able
and lin
ked
OP
to f
am
ilies a
nd
neig
hbours
thro
ugh-
out countr
y. socia
l
and f
am
ily c
onnec-
tions o
f th
e e
lderly
Yes –
private
ow
n-
ers
hip
as a
resourc
e
for
OP
that th
ey c
an
pass o
n to c
hild
ren.
Recip
rocity a
nd g
ifts
from
pare
nt to
child
thro
ughout lif
e.
Irela
nd
Overload h
as n
ega-
Y
es 4
.
½ in s
epara
te
70 c
om
munity
Recip
rocity a
de-
145
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
tive e
ffect
on p
hysi-
cal &
menta
l w
ell
bein
g –
at risk
gro
ups f
or
ow
n
health
24%
FC
in p
oor
health, 30%
thought
health h
as s
uff
ere
d,
25%
inju
red.
Caring f
or
Care
rs-
69 g
roups, C
are
rs
Assoc-
16 g
roups, +
2 o
thers
.
household
s.
Hours
incre
ase w
ith
dependency.
76.8
% c
are
for
1
pers
on, 19.8
% f
or
2.
3,4
% f
or
3+
1-1
9 h
rs-
60.3
% F
C
13.4
% -
30-4
9 h
rs.
26.7
% -
50 h
rs +
.
based p
roje
cts
sup-
port
ed C
om
munity
Applic
ation o
f IT
–
Caring f
or
Care
rs
initia
ted IT
pro
ject
with M
id W
este
rn
Health B
oard
,
CIC
entr
e E
nnis
and
Ennis
I A
ge T
ow
n.
Targ
et gro
up 1
500
not
yet m
ain
-
str
eam
ed.
Poorly d
evelo
ped
and p
oor
legis
lation.
Inte
rnet fo
r shop-
pin
g.
bate
– incre
asin
g
role
of gra
ndpar-
ents
. in
child
care
Only
anecdota
lly.
Inherita
nce o
f hom
e
– Issue w
heth
er
fam
ily h
om
e +
oth
er
assets
should
be
taken into
consid
-
era
tion f
or fu
ndin
g
LT
C.
Italy
-
Eld
er
abuse d
is-
cussed w
ith r
ef to
resid
ential hom
es
but le
ss s
o a
bout
FC
. R
esults o
n F
Cs
feelin
g tyra
nnis
ed
by O
P a
lso a
ppar-
ent (s
pouses a
nd
daughte
rs e
spe-
cia
lly m
ention this
).
2 m
ajo
r A
lzheim
er
gro
ups w
ork
ing
nationally
.
A.U
.S.E
.R.
(NG
O
for
eld
erly c
are
)
recently p
ublis
hed a
“manifesto
of care
rs’
rights
” and a
na-
tional confe
rence o
n
“Support
ing c
are
rs
for
the r
ights
of th
e
pers
ons c
are
d f
or”
H
igh c
ost, m
ain
ly
private
ly p
aid
- S
e-
curity
ala
rm s
ys-
tem
s, vid
eo-
tele
phones, m
echa-
niz
ed s
hutter
lock,
tele
-medic
ine d
e-
vic
es, tr
ansponder
or
mechanis
ed d
oor
(or
win
dow
) opener,
data
netw
ork
(fo
r
rapid
share
d a
ccess
to Inte
rnet)
, bed-
room
inte
rcom
, vis
-
ual and a
uditory
sig
nals
, re
mote
contr
ol appara
tus o
f
Pro
ble
ms o
f guard
i-
anship
of O
P p
rop-
ert
y if th
ey a
re n
ot
able
to look a
fter
them
selv
es.
146
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
cert
ain
functions v
ia
phone, S
MS
or
Inte
rnet, Inte
rnet
websites f
or
FC
s
main
ly d
edic
ate
d to
fam
ilies o
f A
lz-
heim
er’s a
nd p
sy-
chia
tric
patients
.
Luxem
bourg
N
o d
ata
.
No d
ata
N
o –
Alz
heim
er
Socie
ty o
f LU
part
ly
and m
any o
rganiz
a-
tions inclu
din
g
NG
Os f
or
them
but
not
of
them
. B
ut
there
are
3 o
rgani-
zations o
f senio
r
citiz
ens.
35%
of dependent
people
needed in
excess o
f 24 h
ours
per
week. M
ean
tim
e w
as 2
1.2
hours
. – this
has
incre
ased.
3.5
hrs
-13.9
9-3
8.5
%
14-2
3.9
9 –
26.5
24-3
3.9
9 –
20.8
34-4
3.9
9 –
7.4
44-6
3.9
9 –
4.6
64-8
3.5
– 2
.1
But
this
coves
younger
people
–
and m
ore
tim
e
needed b
y y
ounger
(19-4
0)
sin
ce h
andi-
capped. B
ut next
gro
up a
re those
aged 9
0+
, th
en 8
0-
89, 70-7
9.
Tele
Ala
rm,
Senio
r hot lin
es
pro
vid
e info
rmation
Luxem
bourg
pro
-
gra
mm
es a
nd w
eb
site
ww
w.luxsenio
r.lu
?
Malta
No s
tudie
s-
1 d
one
- N
o c
are
rs g
roups,
- T
ele
care
T
he m
ajo
rity
of
147
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
with 1
00 F
Cs for
this
report
. 65.6
per
cent
of
the inte
r-
vie
wed f
am
ily c
are
rs
replied that th
ey
spend w
hole
day in
the c
are
of th
eir O
P,
there
are
pensio
n-
ers
org
aniz
ations
Serv
ice lin
ks O
P
with F
Cs.
Malta’s
eld
erly p
er-
sons b
equeath
their p
ropert
y to the
child w
ho takes c
are
of th
em
when they
becom
e d
ependent.
Deep e
mbedm
ent in
fam
ily s
upport
net-
work
s o
f in
terd
e-
pendence, of giv
ing
and r
eceiv
ing. O
P
are
a b
oon to their
work
ing c
hildre
n
e.g
. financia
l assis
-
tance, baby s
itting,
etc
, conflic
t re
solu
-
tion.
Neth
erlands
150-2
00,0
00 F
Cs
over
/ burd
ened if
part
ner
or
spouse
because involv
es
care
for
24 / 7
/ 1
2,
more
oft
en d
eprived
of in
com
e, use less
serv
ices f
or
FC
s.
FC
s u
nder
65 h
ave
more
tro
uble
com
-
bin
ing w
ork
and
care
when p
rovid
ing
pers
onal care
and /
or
psychosocia
l or
em
otional support
.
11%
of
FC
s o
f O
P
with d
em
entia h
ad
engaged in p
hysic
al
aggre
ssio
n. 30%
of
FC
s r
eport
ed
chro
nic
verb
al ag-
gre
ssio
n
Many s
uch g
roups
inclu
din
g s
upport
cente
rs f
or
info
rmal
care
rs (
and the
national org
aniz
a-
tion for
these s
up-
port
cente
rs X
zorg
),
volu
nta
ry (
term
inal)
hom
e c
are
org
ani-
zations, org
aniz
a-
tion for
info
rmal
care
giv
ers
(LO
T),
and the E
xpert
ise
cente
r fo
r In
form
al
Care
(E
IZ).
2,4
mill
ion p
eople
19%
of th
e D
utc
h
popula
tion o
ver
18
years
pro
vid
e F
C a
t
least 3 m
onth
s +
or
8+
hrs
per
week.
400,0
00 (
18.8
% o
f
all
FC
) in
tense c
are
for
65+, 830,0
00
long term
less in-
tense. A
v. F
C h
elp
for
17.9
hours
per
week F
C g
ive d
o-
mestic h
elp
(75%
)
psychosocia
l sup-
Houses a
re c
reate
d
in w
hic
h p
eople
can
live thro
ughout th
eir
whole
lifespan w
ith
ala
rm s
yste
ms, IC
T-
technolo
gy e
tc.
Som
e p
rofe
ssio
nal
hom
e c
are
org
ani-
sations a
re o
ffering
com
pute
r te
chnolo
-
gie
s f
or
old
er
people
and their c
are
giv
ers
to a
sk n
urs
es b
y the
use o
f w
ebcam
s
and inte
rnet ques-
No d
ata
148
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
.
port
(81%
), p
ers
onal
care
(34%
), though
for
term
inally
ill
FC
s
pro
vid
e m
uch p
er-
sonal assis
tance
(66%
). 6
7%
of F
Cs
giv
e m
ultip
le f
orm
s
of care
. 40%
FC
s
without assis
tance
60%
get help
fro
m
secondary
info
rmal
care
giv
ers
.
tions a
bout care
Norw
ay
FC
spouses o
f O
P
with d
em
entia found
that th
e m
ajo
rity
report
negative e
f-
fects
of
care
giv
ing
on their o
wn h
ealth
Estim
ate
d a
s b
e-
tween 3
% a
nd 6
% -
stu
die
s in the N
ord
ic
countr
ies a
buse o
f
eld
erly v
aries f
rom
1%
to 8
%. M
ore
frequent experi-
ences o
f vio
lence b
y
mid
dle
and O
W in
citie
s. (5
%)
than
countr
y.
Volu
nta
ry o
rganis
a-
tions for
eld
erly a
nd
for
FC
s t
o g
ive in-
form
ation a
nd s
up-
port
as w
ell a
s b
e-
ing w
atc
h d
ogs a
nd
co-o
pera
ting a
gents
in r
ela
tion to the
form
al serv
ice s
ys-
tem
. 13%
(but
risin
g
nos o
f) L
As h
ad
esta
blished s
upport
gro
ups f
or
care
giv
-
ers
; fe
wer
had s
pe-
cia
l cours
es, tr
ain
-
ing o
r consultation
serv
ices f
or
care
-
giv
ers
.
Stu
dy o
f com
ple
te
cohort
fro
m a
ge 8
0
to the d
eath
of each
cohort
mem
ber
show
ed t
ota
l no.
of
years
of F
C r
e-
ceiv
ed b
y w
om
en
was o
n a
vera
ge 8
.8
years
and f
or
men
5.3
years
(i.e. after
the c
are
receiv
er
reached the a
ge o
f
80).
Hrs
of in
form
al
care
to o
lder
(and
dis
able
d)
people
incre
ase w
ith a
ge o
f
care
giv
er,
with a
peak f
or
mid
dle
aged w
om
en (
aged
45-6
6 y
ears
)
Wom
en g
ive 2
.5
There
are
Offic
es
for
Assis
tive A
ids in
every
County
.
Safe
ty a
larm
s a
nd
oth
er
equip
ment are
wid
ely
used b
y e
ld-
erly a
nd their c
ar-
ers
.
Yes-
consid
era
ble
transfe
rs f
rom
OP
as inherita
nce, pre
-
inherita
nce a
nd g
ifts
though this
is s
how
n
not to
influence the
am
ount of care
giv
er
to o
lder
par-
ents
by c
hild
ren -
genera
lly. If p
are
nts
are
in n
eed o
f nurs
-
ing, pre
vio
us h
elp
from
pare
nts
to
childre
n r
esult in
more
nurs
ing b
y
childre
n, and m
ost
so f
or
fath
ers
Eld
-
erly in g
enera
l giv
e
more
help
and e
co-
nom
ic s
upport
to the
younger
genera
-
149
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
tim
es a
s m
uch f.
c.
as m
en.
wom
en
giv
e m
ore
help
than
men d
o to o
ther
household
s –
no
diffe
rences w
ithin
sam
e h
ousehold
.
tions, com
pare
d to
the h
elp
they r
e-
ceiv
e. F
or m
oth
ers
am
ount of help
re-
ceiv
ed a
lso d
e-
pends o
n w
heth
er
she h
ad h
elp
ed h
er
childre
n
Pola
nd
No d
ata
N
o d
ata
. E
xtr
em
e
cases in s
om
e p
ri-
vate
hom
es.
Not F
Cs. P
ensio
n-
ers
’ org
aniz
ations
affili
ate
d to p
olit
ical
part
ies.
No n
ational data
.
Where
co r
esid
ent
difficult to m
easure
– s
om
e s
tudie
s
have s
uggeste
d 1
00
hours
a w
eek,
No d
ata
Y
es-
legally
con-
trolle
d. Im
port
ance
of re
cip
rocity –
esp.
sin
ce s
o m
any a
re
co-r
esid
ent, a
nd
support
of O
p p
en-
sio
n f
or
unem
-
plo
yed.
Port
ugal
56.1
% d
epre
ssio
n
(26.5
% s
evere
,
modera
te)
Needs a
nd p
rob-
lem
s v
ary
by in-
com
e levels
– lei-
sure
an issue f
or
the
better
off, financia
l
help
for
the w
ors
e
off
.
No a
ccura
te d
ata
.
Researc
h r
eveals
very
little –
main
ly
em
otional or
psy-
cholo
gic
al abuse.
(aff
ective b
lackm
ail
by b
oth
part
ies)
No r
ep. gro
ups o
f
FC
s.
Som
e A
lz-
heim
er,
Park
inson
gro
ups.
Where
they e
xis
t
NG
Os a
re e
ffective
in im
pro
vin
g local
initia
tives a
nd p
rovi-
sio
ns. (e
.g. tr
ain
ing,
support
in k
ind, self
help
)
39%
care
alo
ne,
61%
have s
upport
from
socia
l agen-
cie
s, re
latives o
r
housekeeper.
68.3
% c
are
for
more
than 4
hours
p.d
..
56.6
% c
are
every
day, 6.9
% o
cca-
sio
nally, 17.2
% F
C
relies o
n form
al
support
, 6.9
% h
ave
rota
tional care
.
Gre
en P
aper
1997
to f
avour
dis
advan-
taged in Inf. S
oc.
Netw
ork
of
dis
able
d
and e
lderly, M
in. of
scie
nce a
nd T
ech-
nolo
gy o
ffers
fre
e
Inte
rnet.
Port
ugal T
ele
com
(text, t
ext
phone,
Grid. em
erg
ency
term
inal w
ith fre
e
hand p
hone,. A
larm
Serv
ice,, p
ort
able
am
plif
ier,
lum
inous
call
sig
n,
dis
counts
,
Not pro
pert
y, but
exchange o
f goods
and s
erv
ices a
nd
recip
rocity
150
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
financia
l fa
cili
ties in
gain
ing a
ccess to
equip
ment.
Slo
venia
FC
s very
isola
ted
and h
igh b
odily
and
physi
cal st
rain
s
(27.3
%). N
o s
pare
tim
e(1
5%
) and less
tim
e for th
eir fam
ily
(10%
). F
Cs
most
mis
s financia
l help
and h
om
e h
elp
; th
e
third p
lace o
ccupie
d
by h
elp
in a
ccom
mo-
dation o
f O
P in O
P
hom
e 4
5.8
% c
are
rs
did
not know
who to
turn
to for help
.
½ O
P a
buse
d b
y
their c
hild
ren. F
am
ily
mem
bers
or re
lativ
es
were
resp
onsi
ble
for
thre
e q
uarters
of
incid
ences
of abuse
.
FC
s com
mit a
buse
because they a
re s
o
worn
out.
10,9
% f
rom
institu
-
tion w
here
they
lived.
Not per
se b
ut
str
ong N
GO
s –
esp.
Pensio
ners
Asso-
cia
tions
> 2
/ 3
OP
receiv
ed
help
fro
m c
lose
rela
-
tives
severa
l tim
es
a
week a
nd a
50%
every
day. S
om
e
FC
s caring for 2
pers
ons.
FC
. 52.5
%
caring for th
eir p
ar-
ents
for over 6 y
ears
and 1
/ 3
for > 1
0
years
. < 1
/ 3
for up
to o
ne y
ear.
Type o
f help
by F
Cs-
handlin
g fin
ance
(80%
rs)
, household
task
s (7
5%
), a
ccom
-
panyin
g (70%
), h
elp
with n
utritio
n (62.5
%)
nurs
ing a
nd p
ers
onal
hygie
ne (55%
). latter
pro
vid
ed b
y d
iffere
nt
pers
ons
– c
hild
ren
(53.6
%), o
ther clo
se
rela
tives
(39.3
%) and
hom
e n
urs
es
(28.6
%)
‘Red b
utton’,
tele
-
ala
rm s
yst
em
of th
e
Hom
e h
elp
centre
offering h
elp
to p
eo-
ple
in a
health c
risi
s
and the lonely
ones
is n
ot gain
ing u
sers
desp
ite h
eavy in
-
vest
ments
into
it.
Critical im
port
ance
of re
cip
rocity –
esp.
curr
ently w
here
hig
h
unem
plo
ym
ent ra
tes
and f
am
ilies g
et
support
fro
m O
P.
Can b
e m
isused
where
FC
is n
ot a
rela
tive…
How
ever
OP
unw
ill-
ing to s
ee larg
e
apart
ments
sin
ce
they w
ish to leave
pro
pert
y to their
childre
n-
so w
on’t
pay for
care
.
Spain
C
om
bin
ing F
C a
nd
work
ing o
ut of
hom
e
negative h
ealth
effects
.- incre
ase in
Only
academ
ic d
e-
bate
– n
o r
eso-
nance,
Yes.
Especia
lly
Alz
heim
er’ g
roups –
subsid
ized b
y g
ovt.
56%
of F
Cs p
rovid
e
daily c
are
; 22%
every
week, 14%
occasio
nal. M
ostly
Tele
-assis
tance w
as
giv
en to less than
1%
of th
e e
lder
63%
of F
Cs indic
ate
that O
P d
o n
ot
giv
en them
an e
co-
nom
ic r
ew
ard
, 23%
151
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
morb
idity, w
ors
ens
perc
eption o
f health
sta
tus, and in-
cre
ases u
se o
f H
Ss.
64%
FC
s less lei-
sure
, 51%
tired,
48%
no h
oliday,
39%
no v
isit to
frie
nds, 32%
de-
pre
ssed, 29%
health d
ete
riora
ted,
27%
can’t w
ork
,
26%
No t
ime t
o look
after
oth
er
people
,
23%
no t
ime f
or
them
selv
es,
21%
financia
l pro
ble
ms,
12%
reduced their
work
ing d
ay, 12%
gave u
p w
ork
, 9%
conflic
ts w
ith p
art
-
ner.
71.4
% o
f m
ain
care
rs p
sycholo
gi-
cally
not w
ell
OP
in a
ssocia
tions
of pensio
ners
or
wid
ow
s a
lso s
ubsi-
dis
ed p
ublicly
or
by
non p
rofit-
makin
g
entities, in
tended t
o
encoura
ge the e
ld-
erly to lead a
n a
c-
tive life a
nd to o
ffer
them
a m
ediu
m for
socia
lisin
g.
all
day o
r tw
o h
ours
a d
ay
FC
spends a
v. 7 h
rs
a d
ay c
aring, and
may r
eceiv
e h
elp
one h
our
a d
ay.
Fro
m r
est
of
net-
work
Hig
h%
of O
P in
Spain
report
fair to
bad h
ealth
59%
liv
e togeth
er
perm
anently, 16%
live togeth
er
tem
po-
rarily
, 26%
liv
e in
separa
te d
wellin
gs
or
in o
ther
form
s –
larg
e u
rban / r
ura
l
variations in liv
ing
alo
ne f
or
OP
.
Inte
rnet gro
win
g-
for
FC
s "
The E
xpert
s
Centr
e"
experim
ent
to r
esolv
e p
roble
ms
in c
aring for
the
eld
erly, sponsore
d
by the R
ed C
ross
and the O
bra
Socia
l
de C
aja
Madrid. A
website o
ffering a
consultin
g s
erv
ice
Users
are
able
to
find fre
e p
rofe
s-
sio
nal advic
e o
n
e.g
. health, m
eals
,
advic
e o
n legal and
busin
ess m
atters
,
volu
nte
er
forc
e,
addic
tion e
tc.
regula
rly r
eceiv
e
com
pensation a
nd
13%
do f
rom
tim
e t
o
tim
e.
Negative p
erc
eption
of th
e im
pact of
caring o
n the fam
ily
econom
y b
ut an
expense e
specia
lly
in fam
ilies w
ith a
mediu
m-low
eco-
nom
ic s
tatu
s, sin
ce
pensio
ns a
re low
and d
oes n
ot cover
the c
osts
they
cause
Sw
eden
No d
ata
N
o d
ata
though
recogniz
ed a
s a
pro
ble
m e
specia
lly
where
caring f
orc
ed
on F
C -
Yes -
3 m
ain
gro
ups
gro
win
g in im
por-
tance -
Dem
entia
Associa
tion (
1984)
has a
bout 12 0
00
mem
bers
and 1
10
local org
anis
ations
in m
ost are
as; T
he
Alz
heim
er
Associa
-
No d
ata
3 Y
r action p
lan
(1999-2
001)
stim
u-
lating L
As to d
e-
velo
p a
n infr
astr
uc-
ture
of
serv
ices
targ
eting fam
ily
care
giv
ers
. T
he p
lan
funded L
As to e
x-
pand s
erv
ices for
No d
ata
though
assets
of
diffe
rent
kin
ds p
lay a
role
in
the n
egotiation o
f
fam
ily o
blig
ation
152
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
tion S
weden, (1
987.
the C
are
rs S
weden,
1996 -
national um
-
bre
lla o
rganis
ation,
and to p
rom
ote
care
rs´
inte
rest on a
bro
ad s
cale
,
thro
ugh a
dvocacy-,
info
rmation-
and
aw
are
ness r
ais
ing
activitie
s.
care
rs e
.g.
by s
et-
ting u
p c
are
giv
er
resourc
e c
entr
es
that off
er
train
ing,
counsellin
g, support
gro
ups, re
spite
care
, in
form
ation
and r
esourc
es f
or
fam
ily c
are
giv
ers
,
inclu
din
g d
ay p
ro-
gra
ms f
or
their d
is-
able
d f
am
ily m
em
-
bers
. T
he e
xperi-
ences a
nd o
utc
om
e
of th
e C
are
r-300
pro
ject has b
een
syste
matically
fol-
low
ed a
nd e
valu
-
ate
d the r
ecent
years
. A
CT
ION
tele
matics inte
rven-
tion p
rogra
mm
e
used w
ith 4
0 fam
i-
lies is s
uccessfu
l.
Sw
itzerland
Stu
dy c
om
paring N
and S
canto
ns
show
ed d
iffe
rences
40%
report
ed d
e-
pre
ssio
n, 26%
of
Basel F
Cs &
18%
of
FC
s in T
icin
o
show
ed d
epre
ssiv
e
sym
pto
ms.
In B
asel,
Under
exam
ined b
ut
n N
GO
exis
ts t
o
deal w
ith a
buse.
Yes-
for
Alz
heim
er
and o
ther
/
Majo
rity
FC
s p
ro-
vid
e 3
- 2
0 h
rs p
.m.,
the p
eak d
ura
tion
bein
g 6
-10 h
rs c
are
p.m
. W
om
en s
pend
only
a v
ery
slig
ht
am
ount
of tim
e
more
than m
en p
.w.
16.4
% o
f m
en a
nd
153
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
up to 7
0%
of F
Cs
indic
ate
d h
ealth-
rela
ted p
roble
ms.
18.9
% o
f w
om
en
giv
e 2
1 h
ours
+ for
FC
p.m
.
Mem
bers
of th
e
fam
ily p
rovid
e a
n
avera
ge o
f 17.9
hours
of
care
per
week o
ver
a m
ean
dura
tion o
f 6.5
years
UK
D
iffe
rences in la-
bour
mark
et in
-
com
es a
fter
epi-
sodes o
f care
2 / 3
or
4 y
ears
not dif-
fere
nt fr
om
those
not
involv
ed in c
are
over
these inte
rvals
,
but lo
nger
epis
odes
rela
ted to larg
er
gaps in incom
es
betw
een c
are
rs a
nd
non-c
are
rs. w
ith s
ix
or
2,4
00 c
om
pla
ints
made to A
ction o
n
Eld
er
Abuse 5
0%
appro
x b
y r
ela
tives,
28%
by a
paid
work
er,
11%
by a
frie
nd o
f th
e v
ictim
,
most
cases t
akin
g
pla
ce in t
he v
ictim
's
ow
n h
om
e. A
ccord
-
ing to the s
urv
ey,
one in thre
e o
ld
people
suff
ers
som
e
form
of psycholo
gi-
cal abuse; one in
five is p
hysic
ally
abused a
nd the
sam
e n
um
ber
have
their s
avin
gs inap-
pro
priate
ly u
sed;
more
than 1
0%
are
negle
cte
d a
nd 2
.4%
sexually a
bused
Care
rs U
K led b
y
care
rs w
ith N
ational
and r
egio
nal offic
es
114.
Incom
e fro
m
public g
rants
(36%
)
19%
donations f
rom
trusts
and p
ublic
bodie
s, 15%
fro
m
legacie
s, 6%
fro
m
corp
ora
te d
onations
and s
ponsors
hip
,
and 4
% f
rom
mem
-
bers
hip
subscrip-
tions.
Princess R
oyal
Tru
st fo
r C
are
rs –
113 n
etw
ork
s. O
ffer
gra
nts
and tra
inin
g.
Cro
ssro
ads C
aring
for
Care
rs –
202
centr
es –
for
bre
aks
to 3
9,0
00 c
are
rs
4 m
illio
n c
are
rs
work
and c
are
(1 / 9
wom
en a
nd 1
/ 1
0
men c
om
bin
ing
work
with the s
up-
port
of
a fra
il old
er
pers
on
Socia
l S
erv
ices m
ay
pro
vid
e text phones,
flashin
g o
r vib
rating
ala
rm c
locks o
r door
bells a
nd loop s
ys-
tem
s f
or
liste
nin
g t
o
the tele
vis
ion. D
is-
able
d liv
ing c
entr
es
pro
vid
e a
dvic
e a
nd
access t
o m
od.
Support
technolo
-
gie
s in U
K e
.g. E
nvi-
ronm
enta
l contr
ol
syste
ms., P
Cs,
CD
-
Rom
s a
nd IS
DN
lines p
rovid
e O
P
and F
Cs w
ith a
c-
cess to info
rmation.
When s
om
eone
goes into
a r
esid
en-
tial hom
e they m
ay
be r
equired to s
ell
their h
om
e, so indi-
vid
uals
who a
re
likely
to b
enefit fr
om
the inherita
nce o
f
pro
pert
y m
ay b
e
influenced in their
decis
ion to c
are
for
their e
lderly r
ela
tive.
154
Co
un
trie
s
Healt
h a
nd
Well-
bein
g o
f F
C
Ab
use in
FC
sit
ua-
tio
ns
Care
rs g
rou
ps
Ho
urs
of
care
,
Resp
on
sib
ilit
y f
or
FC
New
tech
no
log
ies
Pro
pert
y a
nd
in
-
heri
tan
ce &
recip
-
rocit
y
with p
aid
, tr
ain
ed
care
sta
ff.
155