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1. Rundum Zuhause betreut Home Care Europe Conference Caritas Vienna Irene Pichler Vienna, 4th of June 2009 Verein Rundum Zuhause betreut

2. Points of Departure • High number (no exact estimates) of „illegal“ migrant health care workers in Austria to deliver home-care-services for persons in need of care • Changing patterns of care: reduction of traditional care of relatives, people wish to stay at home as long as possible • New laws passed in 2007 to legalise home-assistance workers • „Hausbetreuungsgesetz“ (home assistance law) entered into force in July 2007 • Changes to the Trade Commerce and Industry Regulation Act regulates the self-employment of home-assistance workers • „Legalisation“ of „illegal“ migrant health care workers in Austria  transition to legal service of 24/7-home-assistance • End of the „amnesty“ by the end of June 2008 Verein Rundum Zuhause betreut

3. Self employed legal Home-Assistance Workers (HAW) • Two legal possibilities: regular employment and self-employment • Most of the new legal HAW are self-employed (employment too complicated) • Necessary to have a trade licence (unregulated trade) • Two-week rotation (2-3 months for Romanians/Bulgarians) • Origin of neighbourghing and other EU-states • Qualification requirements: Caritas - at least the qualification as a home-assistance worker (about 200hours) – since 2009 there is a new requirement for public funding of 24/7-home-assistence • Contractuelle Situation: 1 -„Service-contract“ between the placement agency and the client • 2 - „Home assistance contract“ between the person in need/relatives and HAW that defines the precise activities  monthly payment, social insurance and self employed taxation Verein Rundum Zuhause betreut

4. Contractuelle Situation Caritas „Service-contract“ Home-assistance workers Person in need of care „Home-assistance contract“ Placement Agencies (Partially high recruiting-fees) Verein Rundum Zuhause betreut

5. Services provided by the legal Home-Assistance Workers • Services rendered for people in need of care include the following „home-assistance activities“ (vs. medical care) f. e.: • Support activities in the household (such as cooking, making purchases, etc.) • Support regarding the organisation of daily activities • To assure social interaction for the person in need of care • Preparation for changes in residence • Organisation of home assistance activities • Support in feeding, hydration and prescription medicine, personal hygiene, support in dressing/disrobing etc.  unless medical reasons necessitate a written order („Delegation“) • Includes single medical care activities if delegated by physicians or nurses Verein Rundum Zuhause betreut

6. Caritas‘ offer of 24/7-Home-Assistance • Service has been offered by the Caritas non-profit association Rundum Zuhause betreut since 2007 • Within the non profit association five Caritas dioceses (Caritas of Vienna, St. Pölten, Linz, Salzburg und Graz-Seckau) are working together • This service is offered in five Federal States in Austria: Vienna, Lower und Upper Austria, Salzburg, and Styria • Cooperation with placement agencies regarding the recruitment of HAW (mainly in Slowakia) • „Legalisation Project in 2008“ in cooperation with other Austrian NGOs on behalf of the Austrian Ministry of labour and Social Affairs: information and consulting regarding legalisation Verein Rundum Zuhause betreut

7. Key Services rendered by Caritas • Information and consulting for Austrian families regarding the legal service of 24/7-home-assistance • Care assessment (requirements, health situation, activities) • Recruitment of legal home-assistance workers, check of qualification requirements and knowledge of German as well as occupational aptitude / motivation • „Legalisation“ („ business or trade registration“) • Quality management: check through regular „quality visits“ • Administrative support for families and HAW (regarding social insurance, business/trade registration, etc.) • Mediation and support activities inconflict situations Verein Rundum Zuhause betreut

8. Caritas Quality Assurance • 1 – Home visit by nursing staff • Checklist for the home visit: Personal data, assessment of care needs and existing care assistance-network  decision if this service is appropriate • 2 - Regular quality assurance visits by the nursing staff of Mobile Home Care Services (Caritas Mobile Dienste): • Checklist for the quality assurance visit: assessment of: - customer satisfaction, - competence of the HAW, - evaluation of changes in care needs and the care assistance-network, - suggestions for improvement • If necessary mobile home care services or a written order (“Delegation“) is provided Verein Rundum Zuhause betreut

9. Written order „Delegation“ for medical care activities • In April 08 a new law was passed dealing with „Delegation/Subdelegation“ of medical care, diagnostisc and therapeutic activities (GuKG §§3b,§15) • Regulates that single medical care activities needs to be delegated by physicians or nurses • Development of procedures / documentation forms by Caritas • Training of Caritas employee in these procedures • Information and consulting are given to the client during the home visit • Control during the regular quality assurance visits Verein Rundum Zuhause betreut

10. Services in Detail – Client Perspective • „First home visit“ to assess needs in care und home assistance activities, decides on the admission to the 24/7-home assistance service • Regular quality assurance visits by the nursing staff of the „Sozialstationen“ / regional bodies of the associated dioceses • Recruitment of „qualified“ HAW • „Legalization“ and administrative support regarding social insurance, registration of a business/trade • Continuous contact in the case of conflicts Verein Rundum Zuhause betreut

11. Services in Detail from theHAW`s Perspective • Recruitment activities for self-employed HAW instead of own acquisition activitites, organisational support and strong bond to the organisation • Check of qualification, legal requirements and German knowledge • „Legalization“ - support activities regarding the registration of the business /trade, Caritas/NGO serves as a clearing house for HAW • Further administrative support regarding social insurance regulations, etc. • Regular quality assurance visits by the nursing staff of the „Sozialstationen“ / regional bodies of the associated dioceses: Support as well suggestions for improvement / competence of the HAW • Contact by native-speaking team members in case of conflicts Verein Rundum Zuhause betreut

12. Costs of 24/7- Home Assistance • 1- „Service-contract“ between the placement agency and the client: • Amount for placement and home visit: € 970,- (2 HAW) • Monthly charge: € 155,- • 2 - „Home assistance-contract“ from 65€ to 75€ / per day plus travel expenses; room and board must be provided • Public financing of 24/7-home care: € 550,-/per month  recoverable after the 3rd level of long-term care benefits (federal system) • Sample calculation: 30 days x 65 = 1950,- + € 160,- travel expenses + 155,- Caritas  € 2265,-/per month Verein Rundum Zuhause betreut

13. Results / Status Quo 2009 • High level of interest in the new legal services from Austrian families  less focus on legalisation of „illegal“ HAW • Caritas: about 130 active clients in five Federal States • More than 260 HAW in the labour pool • Regional focus: Vienna / Lower Austria • Countries of origin: about 95% Slovakia (Czeck Republic, Hungary, Romania) • Development of wellcome-folders for clients as well as bi-lingual folder and introductory sessions for HAW Verein Rundum Zuhause betreut

14. Experiences / Challenges • Heavy financial burden for Austrian families already at the limit • Recruitment of „qualified“ home-assistance workers with good knowledge of German and social competence • Lack of entrepreneurial competences / entrepreneurship of HAW • Significant administrative, language and social barrieres; lack of legal information (f. e. on HAW`activities) etc. • Necessity to cooperate with private placement agencies • High expectations of the persons in need /relatives • High potential for conflicts Verein Rundum Zuhause betreut

15. Prospects • Need to promote entrepreneurial competence /improvement of language knowledge /ability • Need for accompanying/advising structures for self employed HAW • Improvement of support / information / further training for HAW (partially excessive demands f. e. dementia) • Differentiation of the service: short-term 24/7-assistance (f. e. relief of the burden on the families), service after hospitalisation • Quality assurance: continuous improvement of quality / quality assurance of the new legal service • New qualification requirements for public funding of 24/7-home-assistance (at least 168 hours theory plus first aid training) Verein Rundum Zuhause betreut

16. Thank you ! Verein Rundum Zuhause betreut