Long term care in Poland

Transcription

1 Long term care in Poland Katarzyna Wieczorowska-Tobis Department of Palliative Medicine University of Medical Sciences Poznań, Poland President of Polish Society of Gerontologicy Permanent Advisor of the Parliamentary Comission for Seniors ( ) Budapest

2 Projected population change, (%)

3 Median age as of 1 January, 2014 and

4 The old age dependency ratio

5 The law on the older persons (60+) The Goverment needs to monitor the situation of the older persons and present it by the end of October each year

6 Live expectan cy M F Live expectancy At birth At the age of 60 years At the age of 65 years Healthy live expectancy at the age of 65 y Population 80 years and older 58% needs help in self-care unable to accomplish able to do with severe difficulties able to do with some difficulties transfering eating bathing 4.3% 8.7% 33.7% 46.8% 3.o% 3.1% 11.5% 17.7% 8.0% 11.7% 31.3% 51.0%

7 The organization of long-term care in Poland 1. LTC Home care Semi-institutional care Institutional care 2. LTC Social care sector Health Care sector

8 Home care: Medical, psychological, sociological and economic aspects of aging in Poland Sources of help (%) Age (years) Family members Social workers Neighbours, friends Others Each subject 75+ : financial care support (care allowance) 153PLN (about 35Euro) SUBJECT with Barthel Index up to 40 point (out of 100) nurse visits SOCIAL WORKER NURSE Lack of coordination; duplicate support & gaps

9 SEMI-INSTUTIONAL care Social care sector Daily home of social care SENIOR+ project (previously - Senior Vigor) National Government established project dedicated to local govermnments to help them to organize daily programs for seniors Funding for: Changes in the infrastructure (the first year) Buying necessary equipment (the first year) Various activities for seniors mln PLN each year: mln

10 SEMI-INSTUTIONAL care Health care sector Pilot project: 41 centers DDOM Daily Home for Medical Care Open 5 days /week For at least 8h daily Barthel Index: points Potential for improvement minimum 30 days maximum 120 day Assessment: geriarician & specialis in medical rehabilitation podkarpackie_ddom_juz_rehabilituje_pierwszych_pacjentow,6573.html No follow up DDOM: run by NURSES PT, OT, Psychologist everyday program As needed: dietition & paharmacist Geratric consultation : as needed Telecare? WSWOP Hospicjum Domowe Paliative Care Voluntary Association Home Hospice Poznań, Poland

11 Social care sector dependency and lack of possibility to organize care at home INSTUTIONAL care DPS (local government, churches, etc) Home of Social Aid (2014: about 0.1% ) 26 family DOPS- 166 beds The subject pays a fixed percentage of 70% of their monthly income ; less than 5% of the subjects are able to cover the costs the rest is paid by the family; in case they can t afford - by the local government. COST: 3000 PLN 1000PLN: 70% - 700PLN: 2300 Nurse Psychologist DPS ul. Bukowska 27/29, Poznań dedicated to elderly individuals Physician family physician limit for consultations DIETITIAN PT Social worker Working team 0.4 workers/inhabinat (including all staff) 439 privat units registrated for 24h care for chronically ill subjects, disabled persons or seniors OT Weekly meetings

12 400 LTC residents (Poznań,Wrocław, Białystok, Lublin) Total Staff 9.9 * > User 9.1 The average percentage of agreement 86.2% The lowest: Company 65.3% Pychological discress 70.5% Eyesight/hearing 70.5% Met needs Unmet needs * > * <

13 Table 1: Detailed characteristics of routine pain treatment in analyzed subjects including MMSE results (only consumed groups of drugs were included) - group A composed of subjects with MMSE results points, group B points, group C points, group D points; p is only shown when it is statistically significant. Group A n=82 Group B n=67 Group C n=144 Group D n=99 No prescribed analgesics 62 (75.6%) 55 (82.1%) 122(84.7%) 89 (89.9%) p= vs. A Routine step 1 (non-opioids) Acetaminophen NSAIDs Routine step 2 - tramadol (weak opioids) Routine step 3 - morphine (strong opioids) Acetaminophen+tramadol (one therapeutic formula) 0 16(19.5%) 0 12(17.9%) 1(0.7%) 17(11.8%) 1(1.0%) 6(6.1%) 2(2.4%) 0 4(2.8%) 3(3.0%) (1.0%) 2(2.4%) 0 1(0.7%) 0 MMSE

14 ZOL/ZPO Home for nursing and medical care INSTUTIONAL care Health care sector institution (2014: +9,4% vs. 2010) person-day Long term nursing service obliged by law to employ PTs, OTs, social workers yet they do it in the least possible extend physisian consultant: the institution is charged for any visit Medical care is paid by NHF The client pays a fixed percentage of 70% of their monthly income for food and accomodation ; the rest is NOT paid (!) Barthel index up to 40 points (subjects with pallaitive and psychiatric diagnoses are excuded) Fast increase in disability rate Barthel index 40 points or low REHABILITATION Barthel index 45 points The system favors subjects with higher monthly income 1000 PLN: 70% - 700PLN 2000 PLN: 70% PLN Subject at home with no support DISCHARGE

15 MAIN ISSUES in institutional LTC in POLAND: 1/ care system dedicated to subjects with dementia is needed as their needs are different than those of individuals with physical disabilities 2/ clear qualification criteria of subjects for the institutions, both in social and health care system, are needed; current system is not needbased 3/ good cooperation between social case sector and health care sector is needed 4/ the continuity of the care and treatment is needed; it has to include primary care, LTC and palliative care systems as well as social services 5/ funding needed to cover real costs of subject s stay in the institution

16 The strategy of responsible development AIM: the improvement of accesibility to services including social and health services Strategic projects: Social policy for the older persons: Security*Participation*Solidarity The Council for Senioral Social Policy (Ministry of Family, Labour and Social Policy) The strategy of Social policy for the older persons (LTC institutions; coordination of health care system & social system)

17 Thank you!