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The Flemish model, a multiplicity of Home Care organizations

The Flemish model, a multiplicity of Home Care organizations. Sarah Willockx. Belgium: Politics and society structure of state. Federal state Competent for specific matters such as ‘social security’ 3 communities : Flemish, French-speaking, German-speaking community

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The Flemish model, a multiplicity of Home Care organizations

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  1. The Flemish model, a multiplicity of Home Care organizations Sarah Willockx

  2. Belgium: Politics and societystructure of state • Federal state • Competent for specific matters such as ‘social security’ • 3 communities: Flemish, French-speaking, German-speaking community • Competent for personal matters such as education and welfare

  3. Flemish or Dutch-speaking community French-speaking community German-speaking community Communities

  4. The social security system • Totally elaborated system: • Elderly pensions • Unemployment benefits • Family allowances • Sickness and disability insurance • 2 pillars • insurance principle • solidarity principle • Control and organisation by federal state

  5. Demographic context per age group of 5 years and per 1.000 inhabitantsSource: www.statbel.fgov.be

  6. Home Care services in Belgium Purpose • Door-to-door care for costumer • Support proximity aid • Promote independency • Non-commercial point of view • No exclusion based on risk, financial situation, race or conviction

  7. Job contents Federal home nursing • Nursing tasks • Help with: - everyday personal hygiene - medical care • Specialized tasks by specialized nurses

  8. Job contents Non-medical home services • Personal hygiene • Domestic help • Cleaning help • General psychosocial and pedagogical support

  9. Job contents Logistic services • Growing demand for logistic help and additional home help • Cleaning help, odd jobs and sitting services + general psychosocial and pedagogical support • Wallonia: elaboration in progress • Flanders: own rules already applied

  10. Job contents Service vouchers • Cleaning, ironing and cooking at home of costumer • Also ironing, transport or shopping services • Employment measure • Fight illegal work • Support families with two partners out working • Accessible for everyone: with or without need of care

  11. Conditions & accessibility Home nursing • Medical care: doctor’s prescription • Personal hygiene: No prescription GP Katz-scale

  12. Conditions & accessibility Non-medical home care services • No formal reference • Contact by: costumers, proximity caretakers or 3rd persons (GP, social service hospital) • Social examination by social worker

  13. Conditions & accessibility Logistic services • No fixed rules • Often same procedure as non-medical home care

  14. Conditions & accessibility Service vouchers • Target group: able-bodied healthy people • Apply at certified organization • Exception in Walloon part: also for non-medical home care services

  15. Organization & caregivers Home nursing • Qualified nurses: bachelor, master or registered • Reference nurse • Wage earning or self-employed

  16. Organization & caregivers Non-medical home care services • Caregiver: certificate regular daytime classes or adult education • Wage earners for a certified home care service

  17. Organization & caregivers Logistic services • Flanders: no specific certificate • Wallonia: sitting services require certificate of professional caregiver

  18. Organization & caregivers Service vouchers • No specific certificate • Employed by a certified firm • Certified firms: commercial or non-commercial • Steady job

  19. Legal & financial framework Home nursing • Federal matter< social security Subsidies rating per nursing act Lump sum: based on degree of need of care • Third party system: user pays nothing • Share of beneficiary can be charged

  20. Legal & financial framework Non-medical home care services • Community matter • Public and private services • Flanders: quota of subsidized hours based on programming figures • Wallonia: subsidies per geographic zone & per service • Wallonia: limited 200 hours per user / trimester • Flanders: no limitation

  21. Legal & financial framework Non-medical home care services • User contribution per hour depending on income and family situation: Flanders: 0.5 €  cost price Gravity of need = reduction possible (average 3.5 €) Wallonia:0.9 €  8 € (average 2.60 €)

  22. Legal & financial framework Logistic services • Community matter How? • Flanders: envelop financing on annual basis per full time equivalent • Wallonia: no specific financial framework user pays small contribution based on income and family situation

  23. Legal & financial framework Service vouchers • Federal matter How? • fixed wage • User buys voucher of 7.50€/hour • Fiscal advantage of 30% (2.25€/hour) • Voucher is worth 20.80€ for the employer • Financed by federal government

  24. Multidisciplinary collaboration & consultative bodies • Types of services not unrelated • Disciplinary and multidisciplinary consideration • Structured formal consideration

  25. Challenges • Ageing and declining population • Solidarity principle under pressure? • Market developments • Job demarcation and competences

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