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Long-Term Care in Austria

Long-Term Care in Austria. Home Care Europe Conference June 3 rd – 5 th 2009, Vienna Mag. Kurt Schalek. Long-Term Care in Austria Framework of LTC. Austria is a federal state Competencies are split between federal and nine provincial governments

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Long-Term Care in Austria

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  1. Long-Term Care in Austria Home Care Europe Conference June 3rd – 5th 2009, Vienna Mag. Kurt Schalek

  2. Long-Term Care in AustriaFramework of LTC • Austria is a federal state • Competencies are split between federal and nine provincial governments • Federal activities are consistent in all provinces • Provincial activities differ between nine provinces • Separation of health care and social system • LTC is primarily subject of the social care system • Health care is involved in LTC when people are sick • Difficulties in offering integrated services • LTC in Austria is a complex system • Many players in the field • Differences for beneficiaries dependent on the province • Complex political processes within this system Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  3. Long-Term Care in AustriaBenefits and Services • Cash benefits • Long-Term Care benefit • Social assistance • Non-cash benefits, services • Services (e.g. home care, nursing homes, counselling) • Facilities (e.g. walking frames, support of age-appropriate adaption of houses and flats, nursing beds) Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  4. LTC benefit (7 levels), social security for uninsured informal carers, financial support for investments and holidays for the major informal carer Federal Ministry of Social Affairs Medical home care (nurses) if hospital care is substituted, assistive technology (e.g. walking frames) Health Care Insurance LTC benefit on provincial level, all kinds of services in LTC, social assistance for residents in nursing homes and clients of home care Authorities of Provinces Services in LTC, social assistance for residents in nursing homes, other financial support, assisted living facilities Municipalities co-payments/deductibles, private investments in assistive technology, services etc., informal care by family carers (75-80% informal arrangements) Individual/Families Players in the LTC-System Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  5. Cash-benefits financed by taxes Federal Ministry of Social Affairs Financed by wage-dependent insurance premiums and tax-financed deficit coverage Health Care Insurance Services and benefits financed by taxes and co-payments Authorities of Provinces Services and benefits financed by taxes and co-payments Municipalities Financed by income and/or private capital, non-paid services by informal carers Individual/Families Sources of finance in LTC Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  6. Long-term care benefit financial support for people in need • Purpose of LTC-benefit (§1 BPGG): • Overall financial contribution to costs related to the need for care/nursing • Furthering opportunities for a self-determined living according to individual requirements • Beneficiaries are classified in 7 levels • From level 1 (least) to level 7 (highest) • Preconditions for entitlement • Living in Austria (under specific circumstances also in EWR-Countries) • Need for care/nursing is expected to last longer than 6 months • Application for LTC-benefit or for reclassification by (potential) beneficiary • Medical examination for assessing need for care according to law • Notification by the responsible authority Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  7. Long-term care benefit7 levels of need for care Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  8. Long-term care benefitHow does the classification work? • Need for care is expressed in time value for tasks • e.g. washing an incontinent person: 4 x 10 min per day • 3 ways how time for tasks can be valued • guide values: can be fixed individually by assessing experts • minimum values: exceeding has to be justified • fixed extra values: can be added for specific groups of clients (e.g. demented people, disabled children) • Law restricts assessment to body-related & functional tasks • ADL: dressing, washing, mobility, eating and drinking (including artificial feeding), elimination, intake of medicine, anus-praeter-care, care of canula, tubes, catheter, klysma • I-ADL: purchase of food and medicine, heating, washing laundry • Disregarded aspects: communication, relation-building, surveillance when time value less than 180 h/month, psychological aspects (e.g. fear), systemic aspects of care (e.g. care-related conflicts with informal carers) Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  9. Long-term care benefitProblematic aspects • Politicians regard results of LTC-benefit assessments increasingly as indicator for need of care. But: • Assessment doesn’t give a full description of need for care • It is designed for distribution of an overall financial contribution only • Time values are designed to fit administrative processes but does not reflect real values • Need for care must be justified by medical expertise instead of nursing diagnoses that are more significant • Assessment doesn’t encompass all dimensions of care (ability for self-care/resources, context factors and goals) • Lack of a standardised assessment tool • Assessment tools are not scientifically evaluated • Assessment focuses on a single moment only, not on a period of time • Access of beneficiaries to other benefits or support programs could be limited by inadequate assessment Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  10. 55,2 % 71,9 % Long-term care benefitStructure of beneficiaries 2007 Number of beneficiaries 2007 Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  11. Long-term care benefitNo. of beneficiaries and cost • Total beneficiaries 2007: 411.976 • Federal LTC beneficiaries: 351.057 • Provincial LTC beneficiaries: 60.919 • Total cost of LTC benefit 2007 € 2.001,8 million • Cost on federal level: € 1.691,5 million • Cost on provincial level: € 310,3 million Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  12. rewards on basis of service agreements social assistance for those who can’t afford co-payments medical home care only co-payments services services co-payments social security for uninsured family carers services and financial support Financing of LTC servicesA basic model Provinces/Municipalities Federal government public providers sick funds private providers LTC-benefit beneficiaries other sourcese.g. donations, sponsors informal care NOTE: This is a general model only. Variations occur in every province. Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  13. Financing of LTC servicesVariations in Austrian provinces • Variations in co-payments by beneficiaries • Also variations in • mode of client allocation (decentralised/centralised models) • maximum extent of public supported service hours • mode of accounting (e.g. rewards per service hours, service quota) Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  14. Financing of LTC services Structure of cost • Cash benefits vs. non-cash benefits/services • Cost for cash benefits (2006): € 1.925,04 million • Cost for services/non-cash benefits (2006): € 1.332,34 million • forecast: cost for services will raise faster than cost for cash-benefits • Cost by territorial authorities • Cost on federal level (LTC-benefit, 2006): € 1.621,40 million • Cost on provincial level (2006): € 1.635,74 million • Cost on municipal level (estimation): € 400,00 million • Provincial expenditures will increase faster than on federal level • Public expenditures vs. private effort • Public expenditures in LTC (2006): € 3.257,38 million • Estimated value of informal care: € 2 – 3 billion • Estimated co-payments by beneficiaries: 550 million • No data on care-related private expenditures available Sources: WIFO (2008), Quantum (2007), Schneider et al. (2006) Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

  15. Thank you for your attention! Contact Kurt SCHALEK Österreichische Caritas Zentrale (ÖCZ) Albrechtskreithgasse 19-21, A-1160 Vienna Phone: 0043 1 488 31-436 eMail: k.schalek@caritas-austria.at Home Care Europe Conference, June 3rd – 5th 2009, Vienna, Mag. Kurt Schalek

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