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Europe_________________________

GermanyDulcinea Wetherell

+Interest

Traveled to Europe in Summer 2014

Learning from the Holocaust

Revisited Germany-Berlin and Munich

+EuropeHistory of Home Care

Relied on informal care (primarily family) and voluntary or church provision

Late 19th Century-growing state involvement in health and social welfare

Large scale institutions became dominant

Criticism of these institutions started in the 1950’s

Home care provided as an alternative to deinstitutionalize

Acknowledge importance of providing a spectrum of care for vulnerable groups, yet varies in each country

+EuropeInformal Care

Informal Care

Southern Europe-informal care remains the dominant source of homecare

Northern Europe-informal care is less common, focuses on providing companionship and support

Many countries have an organizational model in which the health component of home care is part of the health care system and the social component is part of the social system

In other countries, policy makers provide home care within a single organization under the responsibility of one institution: the municipalities

+EuropeInformal Care (continued)

Little is known about the private market of care across some European states

Contribution and Opportunity costs of Informal Care: Scandinavian Countries- exchanges of care and transfers

within families are a matter of choice, not prescription, due to services directed towards individual

Meditteranean Countries-family obligations placed more on extended family

Western Europe-family obligations directed primarily around the immediate family

+EuropeA Growing Need for Home Care

Demographic Shifts

Social Changes

Changes in Epidemiology

Science and Technical Innovation

Changes in Attitudes and Expectations

Policy Priorities and Choices

+View from St. Peter’s ChurchMunich

+Disability Law in Germany

Disabled People Section 2 para. 1 SGB IX defines disabled people as persons

whose physical functions, mental capabilities or psychological health are highly likely to deviate, for more than six months, from the condition which is typical for the respective age and who participation in social life is therefore impaired

Degree of Disability Scale of 20-100 (Versorgungsamt) Severely Disabled vs. Disabled

+GermanyOverview of Home Care Sector

1994-Home and Institutional Care Act

1995-Social Long Term Care Insurance

Guidelines only relate to physical condition, not mental (i.e. learning disabilities or dementia)

Examine the care of needs based on: Body care Nutrition Mobility Household Help

+Overview of Home Care Sector

+Bavarian AlpsGarmisch

+Providers of Home Care

Federal States work with Medical Review Board of the Statutory Health Insurance Funds to assign level of care to the person

LTC providers are supported either locally, by the federal states, or by non-profit organizations (LTC trainings)

Supply contract (Versorgungsvertrag) between institutions and insurance funds to ensure type, content, and extent of care the care institution provides

Types of Services: Assisted living residences Care cooperatives Nursing Services and ambulatory medical services Volunteering and non-profit self-support organizations

+Financing and Benefit Recipients

LTC Insurance financed by contributions based on gross income

Shared equally by employers and employees based on a pay-as-you-go system

69.48 Million people are insured under the Social LTC scheme

One in five people (19.2% or 307,900 people) with disabilities between 15-64 years of age

+Number of Beneficiaries

About 9.5 Million People have private LTC insuranceAbout 2.3 Million People benefit from provided care services

+Holocaust MemorialBerlin

+PESTILE Analysis

Political and Legal Factors

Economic Factors

Social Factors

Technological and Environment Factors

+Why is there so much interest in Long Term Care?

Low birth rates

Restrictive Immigration Quotas

Increased Life Expectancy

Less interest in institutionalized care

More than two-thirds of the LTC benefit recipients (69.1%) reside at home

Survey: 90% of respondents felt that social and health care systems should help people to remain in their homes for as long as possible

+East Side GalleryBerlin Wall

My God, Help Me to Survive This Deadly Love (Lenoid Brezhnev and Erich Honecker)

Captured in 1979 during the 30th Anniversary of the German Democratic Republic

+Sources

The German Social Long Term Care Insurance: Structure and Reform Options, IZA (Institute for the Study of Labor), Discussion Paper Series, 2007

More and Better Jobs in Home-Care Services: Germany, European Foundation for the Improvement of Living and Working Conditions, 2013

The Solid Facts: Home Care in Europe, World Health Organization, 2008

Disability Law in Germany: An Overview of Employment, Education, and Access Rights, German Law Journal, Vol. 5, No. 11

Majority of Pictures taken by Dulcinea Wetherell