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Informal care - can we make success

instead of burden?

MUDr. Darina Sedláková

Kancelária WHO na Slovensku

dse@euro.who.int

Interlinks seminar, Bratislava, 3 December 2009

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Informal care is intended for

• Mostly for elderly with chronic conditions – somatic,mental, most often combined

• As a result of better health technologies and health care more and more also for children, adolescents and middle-aged people

Precondition: compensated disease / condition, no signs of acute illness

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% people 60+, 2007

Country %

1. Japan 27,9

2. Italy 26,4

3. Germany 25,3

7. Bulgaria 22,9

19. Hungary 21,3

21. Czech Republic 21,1

45. Slovakia 16,8

100. Malaysia 7,4

150 Nicaragua 5,0

190. Niger 3,2

Sourcej: United Nations Department of Economic and Social Affairs, Population Division, 2007

Development 1950 - 2050 (%)

22% ...2 billion people

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Global population pyramid

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eAge pyramid EU-25

(2004, projection 2050)

Source: Healthy Ageing: key stone for a sustainable Europe, DG Sanco, January 2007

-Since fifties: LE at birth +2,5 years

-Till 2050 number of EU citzens will drop by 11,7% (migration, low fertility

rate)

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0–4

5–9

10–14

15–19

20–24

25–29

30–34

35–39

40–44

45–49

50–54

55–59

60–64

65–69

70–74

75–79

80–84

85+

Vek

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iny

(v r

okoc

h)

Muži Ženy2020

2002

1986

Populácia (v tisícoch)

300 200 100 0 100 200 300

Age pyramid - Slovakia

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Consequences of ageing for elderly individuals

• Declining adaptational capacities and proactivity

• Biological ageing:- functional, cognitive, visual, hearing disabilities- injuries and falls

• Increasing dependency ratio:- in the home: self-maintenance and activities of daily living(ADL) - in the community: instrumental ADL (IADL)

• Frequent institutionalization

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Age-related dependencies

ADL difficulties• Self-care• Bathing/Showering• Dressing• Eating• Walking• Getting in/out of bed

and chair• Using toilet

IADL difficulties• Using telephone/

communication means• Doing light housework• Doing heavy housework• Preparing meals• Shopping • Managing money

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Loss of capacities at old ageSource: BMFSFJ (1996)

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Impact on living conditions / urban design

- improved accessibility of buildings

- adequate design of urban equipment

- adequate design of streets and sidewalks

- adequate design of public transport

- accessibility to public services/ shops

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Homes: which adaptations are needed?

Source: Dr Nygren & Dr Kliemke LARES, Germany

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Recent considerations (1)

• Some policy makers fear that providing more formal care services will lessen the involvement of families.

Studies show that this is not the case.

• When appropriate formal services are provided,informal care remains the key partner (WHO,2000c).

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Readiness of health systems

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Recent considerations (2)

• Of concern are recent demographic trends :

- increase of childless women,

- changes in divorce and marriage patterns

- smaller number of children of future cohorts of older people

} a shrinking pool of family support (Wolf, 2001).

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Caregivers must be supported so that they do not get ill themselves

• Need to be well informed about the condition of the cared person and its possible progress

• Need to know how to obtain the support services that are available (formal care: visiting nurses, home care, provision of assistive devices, respite care, etc.)

• Need income security (e.g., social security coverage and pensions),

• Need help with housing adjustments that enable them to care for people who are disabled

• Be entitled to disbursements to help cover caring costs

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Such help / entitlements

• need to be available to all, not just to those - who know about them, or - who can afford to pay for them

BUT• Professional care-givers also need training

and practice in enabling models of care thatrecognize cared for people’s strengths and empower them to maintain even small measures of independence when they are ill or frail.

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Policy implications (1)

Information and education about LTC needs to be incorporated into curricula and training programmes for all health, social service and recreation workers as well as city planners and architects.

Basic principles and approaches in LTC care should be mandatory in the training of all medical and nursing students as well as other health professions.

Societies that value social justice must strive to ensure that all policies and practices uphold and guarantee the rights of all people, regardless of their helaht/social condition

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Policy implications (2)

Support informal caregivers through initiatives such as respite care, pension credits, financial subsidies, training and home care nursing services.

Recognize that older caregivers may become socially isolated, financially disadvantaged and sick themselves

Enact policies and programmes that recognize and support the contribution of unpaid work in the informal sector and in caregiving in the home.

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New paradigm: “a society for all“

• Recognition of the contributions of all people who are ill, frail and vulnerable and championing their rights to care and security.

• Educating young people about LTC and paying careful attention to upholding the rights of people in need of care will help to reduce and eliminate discrimination and abuse.

• This paradigm takes an intergenerationalapproach that recognizes the importance ofrelationships and support among family members and generations.

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Challenge

How to achieve a balance among:

1. Self-care (people looking after themselves)

2. Informal care (care from family members and friends)

3. Formal care (health and social services in out-patient and in-patient facilities