integrated social and health services for older people: an italian example (emilia-romagna)
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“Integrated social and health services for older people: an ital ian example (Emil ia-Romagna) ”
Raffaele Fabrizio
Bishkek, April 10 th 2015
CENTRAL Goverment-Pension National care allowance
-National Health system Standard professional skills
- National FUND
- compulsory standard of care
REGION Organisation regional health care
Social services planning (rules, standard, funding):
authorization
accreditation
network (public and private) coaching
Local Authorithies-Needs assestment -planning service with public fund support
-use of resource ules for copayment
-- contracting with providers monitoring quality
•About 450€ per month - criteria: 100% disabled people, need to be helped for ADL (activities day life)
•No income’s limits
•No control about how the money is used
•No link with services' network
• PEOPLE RECEVEING NCA:
Italy: about 1,2 mln people =>65years old (about 6 milliards Euros per year)
Emilia-Romagna 103.000 people: 10% of =>65years ; 20% of =>75years , about 600 millions € per year
NATIONAL FUND? THE NATIONAL CARE ALLOWANCE (NCA)
Changes in the context: changes in the life
Pension system Recent changes in the pension system
Current average age at retirement
59,5
Prospective average age at retirement
67
Number pensioners in ER (2012)
% pensioners % pensionars on less than euro 1.000/month
National average monthly pension
1.331.283 30 40 832 euro
Local authorithies categories per number of
inhabitans(to 01.01.2014) Number People %
Up to 1,000 21 15.016 0,3
From 1,001 to 5,000 135 399.926 9,0
From 5,001 to 30,000 171 1.877.547 42,1
From 30,001 to 100,000 12 575.429 12,9
> 100,000 9 1.591.328 35,7
EMILIA-ROMAGNA REGION
Inhabitants: 4.459.246 1.1.2014
9 PROVINCES 348 MUNICIPALITIES
EMILIA-ROMAGNA:context data
ECONOMICS
GDP per capita 2013E-R 32.500E-R 32.500Italy 26.400Italy 26.400EU 28 27.000EU 28 27.000
From ISTATFrom ISTAT
Unemployment rate 15-64 2013
Total Total E-R 8,5%E-R 8,5%Italy 12,2%Italy 12,2%
EU28 10,8%EU28 10,8% Older persons employment rate, persons
aged 55 to 64 years, Lisbon strategy Goal 50%
Italy 30 ER 40
Elderly : not only costs. elderly helps helderly volunteers and not only elderly (grandfather and grandmother «canguro»)646,520 at regional level (55,4% male – 44,6% female)
14,5% of total population Age of volunteers total % % in class 18-64 years 512.756 79,3% 19,3=>65 years 133.764 20,7% 13,6
services for elerderly also an economic opportunity
MOBILITY
Great help to elderly people is provided by social transport (to health services, cultural and social events, etc.) run by volunteer organisation (mainly by retired people)
Social transport by volunteers (2010)
Hours 1.171.803
Number transports 550.071
km 11.697.416
EMILIA-ROMAGNA REGION: DEMOGRAFIC TRENDS
1981 2001 2005 2013 2020
=>65 16,4 22,2 22,7 22,8 22,2 =>75 5,8 10,7 11,3 11,9 11,7 =>80 2,8 5,9 6,6 7,3 7,5
1981 1991 2001 2008 2013 2020
0-14 671.248 447.907 470.293 547.512 560.379 595.193 60-64 201.308 259.049 266.191 254.930 269.357 275.325
65-69 226.727 252.898 239.830 252.548 248.534 246.352 70-74 187.209 167.540 224.557 227.191 239.643 241.443 75-79 120.567 167.056 196.819 196.640 205.450 194.509 > 80 108.844 178.021 236.259 291.829 324.426 346.567 Total 3.922.388 3.909.512 4.037.095 4.275.843 4.471.104 4.635.400
E-R Italia UE 25
% 0-14 anni 12,3 14,1 16,2
% 65 anni e più 22,8 19,5 16,7
% 75 anni e più 11,9 9 7,6
% 80 anni e più 7,3 5 4,1
Aging Index 167,9 147,2 112
EMILIA-ROMAGNA REGION: AGING INDEX
E-R
Resident population
Total males Foreign males Total females Foreign females
- 53% of foreign population between 20 & 45 years old
- Under 18 are increasing (23%)
GENDER
NATIONALITY
AGE
Age structure of the population residing in the ER by gender, citizenship and single year of age, 01/01/2013
•REGION: (Health services and FRNA)
•ELDERLY: (people and families, including us of NCA)
•LOCAL AUTHORITIES
WHO PAYS THE COST OF SERVICES?
NATIONAL FOUNDS?
40%
40%
20%
AN integrated system:Not only social and health
The mainly problem: integrate all local policies(urbanistic planning, housing, transport, long life learning, tourism, social and health)
FOCUS NOT IMPROVING ADMINISTRATION BUT ON THE SINGLE INDIVIDUAL.
FRAIL ELDERLYMultifactor approach
health problems,
functional deficit,
social context,
incomes
loneliness
no close relations
No possible a general model without context analysis
0
4
8
12
16
20
24
28
32
36
40
44
Meno di 25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 e oltre
% M in unip %F in unip % MF in unip
% total population
11,5%
% =>75 34%
% =>85 38%
% Femm =>85 46%
FAMILIES COMPOSED BY ONLY 1 PERSON (BY AGE
GROUPS)
Services network for Services network for
Not-selfsuff icient Not-selfsuff icient elderly people elderly people
SENIORS HEALTH:
3 LEVELS OF INTEGRATION
INSTITUTIONALAGREEMENT BETWEEN
MUNICIPALITY AND AUSL
ORGANIZATIONAL-OPERATING SENIOR ASSISTANCE SERVICE (SAA)
Case manager
Local Geriatrical evaluation Unit
(UVGT)
PROFESSIONAL
GERIATRICAL EVALUATION
UNIT (UVG) •GERIATRICIST•NURSES
•SOCIAL WORKERS
•MULTI-DIMENSIONAL EVALUATION•INDIVIDUAL PLAN (PAI)•PROPOSAL USING SERVICES•FOLLOW UP
GP
OTHER SPECIALISTS
Integrated Home care
Nursing homes =CRA
Caregivers and family assistant
supporting
Day centers= CD
Total no. of
services
Users per service
% of services
per =>75
population
Providers
Public
Private
non- profi t
Privatefor-
profi t
TOTAL
Residential(nursing homes)
328 17.556 3,1% 89 186 53 328
Day Care Center
215 3.342 0,6% 92 108 15 215
Regional Care Allowance
20.500 people
4 different levels in relation to the level of care provided by relatives: 280, 450, 700, 1050 euro per month
Home care services
129 24.207 30 99 0 129
Day social activity center 354 Center 135.000 Members
Volunteer Association
SERVICES FOR THE ELDERLY in Emil ia Romagna Region
National Care Allowance 105.000 (=>65 years)
490 euro per month In ER 600.000.000 euro per year
Women from foreign Women from foreign countries (mainly Eastern countries (mainly Eastern European) take on the task European) take on the task
of caring for elderly and of caring for elderly and disabled people, sharing the disabled people, sharing the
same home.same home.
How ointegrate family How ointegrate family assistant in the network?assistant in the network?
How to reduce black market How to reduce black market for home care?for home care?
Family assistants
• Integration of all actorsIntegration of all actors
Some lessons we learnt
• Access system:Access system: Single door systemSingle door system
Mult idimensional evaluationMult idimensional evaluation Case managmentCase managment
• Support caregivers and family Support caregivers and family assistantassistant
TraningTraning Respite care servicesRespite care services
Care allowanceCare allowance Support self help groupSupport self help group
Some lessons we learnt
• Planning specific approach for Planning specific approach for emergencies:emergencies:
Hospital discharge Hospital discharge Suddenly changes health or in the Suddenly changes health or in the
support ing familysupport ing family Climate emergency (heartquacke)Climate emergency (heartquacke)
• Provide services Provide services
• Integrated data systemIntegrated data system
• Innovation in soft, f lexible and community Innovation in soft, f lexible and community services and opportunit iesservices and opportunit ies
Some lessons we learnt
• Professional integration:Professional integration: Good training for specif ic skil l Good training for specif ic skil l
Training and upgradeTraining and upgrade Common approach and language for all Common approach and language for all
professionalsprofessionals Common training on good relation with Common training on good relation with
elderly people and thei relativeselderly people and thei relatives
THANK YOU FOR YOUR ATTENTION