Towards preventive long-term care pathways
for older people
A case example from Austria / Vienna
2013 National Conference on Ageing
Moscow, October 9 -10
Georg Ruppe
I.
- Long-term Care (LTC) – a concept in
transition
- Prevention and Rehabilitation within LTC
II.
LTC practice in Vienna –
What we tend to see:
-Long-term Care (LTC) – a concept in transition
-Prevention and Rehabilitation within LTC
What we see less:
-Long-term Care (LTC) – a concept in transition
Towards an integrated system of LTC
– an analytical
review:
Informal carers
:
family, friends,
‘migrant carers’
Health care
system
Social care
system
Services Residential care Providers Professions Methods Legal Framework Policies Hospitals - Services Providers - Professions GPs - Methods Legal Framework PoliciesIdentity - Policies - Structures -
Functions - Processes -
Resources/Funding
The formal –
informal divide
The health-social care
divide
Long-term care
linked-in, co-ordinated,
integrated?
Users
-Long-term Care (LTC) – a concept in transitionPrevention and Rehabilitation within LTC
Why this
issue?
-
Context-related
preventive and rehabilitative measures
represent highly
potential elements
for sustainable LTC
-
Still
under-developed
regarding political as well as scientific
awareness
-
“Older people with dependency problems and disabilities were not
particularly evident as target groups for health promotion and preventive
measures”
(HealthProElderly literature report)
-
Little research has been undertaken and little evidence
provided
for the effectiveness and meaningfulness of conventional
as well as innovative approaches
-Long-term Care (LTC) – a concept in transition
Prevention & Rehabilitation within LTC
Practical approaches at two layers:
Comprehensive,
context / system
related
P&R concepts
(bottom-up)
Specific,
conventional
P&R measures
(top-down)
Multidisciplinary work / assessments
Financial security Discharge management Coordination between sectors and services
Support by / for informal carers (families) Mobile health & care services
ICT Information / Counselling
Community
(Formal and/or informal
health and care
services in private
settings)
Intermediate
(Assisted and
community living
arrangements, day
care, respite care,…)
Acute
(Hospital care)
Residential
(Nursing homes, Old
age homes with care
units)
Preventive medical check-up Hip protectors Vaccinations Cognitive training
Remobilisation
Rehabilitation in Rehab.-Centres Palliative treatment Physio/Occupational Therapy Fall prevention Lifestyle counselling
-Long-term Care (LTC) – a concept in transition
Good practice examples in the case of Austria
Comprehensive,
context / system
related
P&R concepts
(bottom-up)
Specific,
conventional
P&R measures
(top-down)
Multidisciplinary work / assessments
Financial security Discharge management Coordination between sectors and services
Support by / for informal carers (families)
Mobile health & care services
ICT Information / Counselling
Community
(Formal and/or informal
health and care
services in private
settings)
Intermediate
(Assisted and
community living
arrangements, day
care, respite care,…)
Acute
(Hospital care)
Residential
(Nursing homes, Old
age homes with care
units)
Preventive medical check-up Hip protectors Vaccinations Cognitive training
Remobilisation
Rehabilitation in Rehab.-Centres Palliative treatment Physio/Occupational Therapy Fall prevention Lifestyle counselling
-Long-term Care (LTC) – a concept in transition
II. LTC Practice in Vienna –
Challenges and Implementation
System/context related P&R
along LTC pathways in Vienna
a) Multidisciplinary work
Acute care
→
Majority
of older patients
with poly-morbidities on wards with
restricted resources/motivation for appropriate therapy and remobilisation
•
„Geriatric Acute Care/Remobilisation“ (AGR)
– with primary/secondary admission
•
dedicated to older patients with complex and/or chronic health problems
•
Since 1999 plan for nationwide implementation, defined quality criteria (staffing,
infrastructure, available services/professions)
•
Established within units for Internal Medicine / Neurology
•
Core elements:
Comprehensive geriatric assessment
→ multidisciplinary diagnosis and therapy, activating
care, remobilisation and social reintegration
•
approx. 40 AGR in 6 of 9 provinces
In Vienna in 2009: 358 beds; by 2015: plan for 434 beds
(1)•
„Day clinic“
•
In association with AGR facility
•
currently 4 all over Austria (Wien, Klagenfurt, Gmunden, Salzburg)
(1) ÖBIG (2010), Österreichischer Strukturplan Gesundheit 2010. Wien: BMG.
b) Support by/for informal carers (family)
Informal care at home
80-85% of care dependent elderly receive care at home from
one or more relatives.
(1)(1) Source: BMSK (2008) Bericht des Arbeitskreises für Pflegevorsorge 2006. Wien: Bundesministerium für Soziales und Konsumentenschutz.
(2) Pochobradsky et al, 2005; Carers of recipients of federal LTC allowances only; n = 1.151
(2)
Informal care at home
→ Support by/for informal carers
(examples)
•
Information
−Project “Quality assurance for care at home”: around 20.000 home visits/year (Federal Ministry for Social Affairs together with social insurance /”SV Bauern”)
−Care telephone; Internet platform (http://www.pflegedaheim.at/); Social help lines, Patient Advocacy etc.
−Various kinds of “Preventive home visits” in all regions of Austria
•In-cash services
−Public subsidies for social health and pension insurancecontributions of family carers (LTC allowance level 3 and above)
−Financial support for the timely limited replacement of a family carer (LTC allowance 3 and above)
•In-kind services
−Day-care centres (waiting lists in Vienna; private out-of-pocket expense)
−Respite care / Transitional nursing home admittance (max. 5w/year; private out-of-pocket expense) −Mobile care services ( with public subsidies)
c) Mobile health & care services
cc) Mobile health and care services
→ Hospize & Palliative Care
National plan for hospice- and palliative care
in Austria
Source: HOSPIZ Österreich, ÖBIG 2004
Preventive
and
cost-efficient !
Average costs in last month of life:
MPT:
ca. 730.- €
Hospital: ca.
– 2.400.- €
(from 5.900.- to 3.500.-)
Total savings. ca.
- 1.670.- €
Joanneum Research (2008), Mobiles Palliativteam Graz. Berechnung der finanziellen
