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Setting the scene for a successful
transition from institutional to
Community-based Care in the health
sector
Magali Lenoël, Jarosław Hawrysz
European Commission
Warszawa, 6 October 2016
Introduction: Actions supporting the development of
Community-based Care services at national level
Part I- Results of the questionnaire to the managing
authorities
• Questions n° 1&2:
• Question n° 3:
• Question n° 4:
Type of actions
Challenges
Integrated approach ESF/ERDF
Part II- Issues to be further discussed - COM assessment
Part III- Guiding principles for a successful transition to
community-based care
Part IV- Workshops
Introduction: Financial allocation for health and
social infrastructure that are potentially linked
to DI
ESF
• Coordinated Care System development (OOK) 45 mln €
• Models Daily Medical Care Homes – (DDOM) 10 mln €
• Studies for doctors and nurses - 160 mln €
• Training for the medical personnel - 48 mln €
ERDF (regions)
• Health infrastructure (including primary care, ambulatory care and palliative care): 1, 37
billion EUR
• Social infrastructure (including housing): 1, 16 billion EUR
Part I- Questions n°1&2: Type of actions
Support to elderly care
→ 13 regions
Daily and family care homes for elderly
→ 4 regions of which
•
2 referred to the model od Daily Medical Care Home developed under OP KED
Palliative, geriatric and long-term care
→ 8 regions
Mental care
→ 11 regions of which
•
3 intend to develop specialised care centres for people with mental disorders
•
2 mention crisis intervention services
Telecare
Supported housing
Rental of equipment
Information and education activities for carers
Adaptation of health infrastructure to needs of elderly/pwd
Development of pre-natal care
Actions for integration of social and health services
Access to POZ and AOS
Coordination of medical care
Disability homes
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7
7
5
3
2
2
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1
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regions
regions
regions
regions
regions
regions
regions
region
region
region
Part I- Question n° 3: Challenges
• Sustainability of investments and guaranteed future funding for social and health
services- major concern
→ 10 regions
• Limited incentives in the national framework to support the transition to Communitybased Care
• Lack of assurance on the quality of the services (models and standards)
→ 6 regions
→ 6 regions
• Development of a Strategic vision and expected activities - missing
→ 5 regions
• Limited awareness about de-institutionalisation among stakeholders
→ 5 regions
• Knowledge on DI concept and lack of national examples
→ 5 regions
• High demand / Real needs recognition
→ 4 regions
• Human resources and in particular medical staff constraints
→ 3 regions
• Unclear demarcation line between social and healthcare services
→ 3 regions
• Integrated approach- complementarity between ERDF (infrastructure) and ESF
(services)
→ 3 regions
• Profitability of investments in institutions below 30 persons
→ 1 region
• Lack of vision for the future of large-scale institutions
→ 1 region
Part I- Question n° 4: Integrated approach
ESF/ERDF
• Bonus points in selection criteria
→ 8 regions
(Attention! Provisions of Regional Operational Programmes
require admissibility criterion. Selection criteria should be adapted
accordingly)
• Cross-financing can be useful
→ 3 regions
(Attention! Does not guarantee an integrated approach)
• Integrated competitions
→ 3 regions
• Integrated projects
→ 2 regions
• Role of the managing authority
→ 2 regions
Part I- concluding remarks on the
questionnaire
• Most actions aimed at developing Community-based Care (related
services and infrastructure) or provisions of places of short-stays
• Relatively few "strategic actions" are foreseen except for ex. the
creation of a network of mental health clinics/teams
• Beneficiaries driven process versus needs of the individuals
• The main focus is on social services. There is little focus on the
synergies between health and social services
• Systemic/structural obstacles hamper the implementation
• Integrated approach (between ESF and ERDF) is difficult (for
example timing of competitions)
Part II- Issues to be addressed for a
successful transition to community-based
care
• Funding for health/social services and long-term
sustainability of investments
• Quality of services
• Strategic vision (framework) and strategic actions at
national and regional level
• Medical staff
• Synergies between health and social services
• Integrated approach for the provision of
services/infrastructure
Part III- Guiding principles for the selection of
operations
Starting point- assess INDIVIDUAL'S NEEDS #
beneficiaries driven process
•
Assess local demand taking into account the long-term sustainability
of the investments
•
Develop quality standards aimed at strenghtening independent living
•
Ensure complementarity between infrastructure investments (ERDF)
and provision of services (ESF)- Admissibility criterion!
•
Promote coordinated care
•
Support to large-scale institutions is excluded
Health
Geriatrics
Hospital
if in line with maps
 Geriatric ward
Stationary non-hospital care
if in line with DI principles
Home




Mobile patient
Primary Health Care (POZ)
Ambulatory Specialist Care (AOS)
Geriatrics Clinic (poradnia
geriatryczna)
Coordinated Care Organisation
Patient at home
 Community-based nurse (POZ)
 Geriatric Care Team (Zespół Opieki
Geriatrycznej)
Long-term
care
 Curative plant (ZOL)
 Nursery plant (ZOP)
 Medical Care Daily Home (DDOM)
 Long-term care nurse
 Long-term care team (zespół
długoterminowej opieki domowej)
Palliative and  Palliative ward
hospice care
 Stationary Hospice
 Palliative Medicine Clinic
(Poradnia Medycyny Paliatywnej)
 Home hospice
 Mental Health Centre (Centrum
Zdrowia Psychicznego)
 Community care team (Zespół
leczenia środowiskowego)
 Social Services Centre (Centrum
Usług Społecznych)
 Daily Care Home (Dzienny Dom
Opieki)
 Senior – Wigor Home?
 Self-Help Home (Środowiskowy
Dom Samopomocy)




Mental
health
 Psychiatric ward
Social
services
*The scheme is internally developed
and is not meant to be exhaustive.
 Social Assistance Home
 Family Assistance Home
 Homes run as commercial
activity
 Regional therapeutic care
facility for children
(Regionalna placówka
opiekuńczo-terapeutyczna)
Care services
Specialist care services
Assistant services
Sheltered/Supported apartments
Financing
Legal basis
Health services
National Health Fund (NFZ)
Ordinances of Minister of Health
Scope
Tasks of a nurse of the Primary Health Care:
1) health promotion and disease prevention;
2) care services;
a) implementation of the nursing care for beneficiaries in
various states of health and disease in accordance with
current medical knowledge and modern standards of
nursing care;
b) execution of nursing care in accordance with separate
regulations;
c) preparing and motivating to the self-care
3) diagnostic services;
4) medical services;
5) rehabilitation services.
Professions
Medical doctors, community-based nurse, long-term nurse,
medical carer, psychologist, speech therapist, occupational
therapist, a specialist in the field of medical rehabilitation,
physical therapist
*The scheme is internally developed and is not meant to be exhaustive.
Social Services
Gminas'/poviats'/MoFLSA budgets
Law on Social Assistance,
Ordinances of Minister of Social Affairs
Guidelines TO9
Care services at the place of residence:
a) assistance in meeting everyday needs
b) hygienic care
c) care prescribed by a doctor, supplementary to the care provided
by a nurse;
d) ensuring contact with the environment
Specialist care services
a) care as a supporting treatment process, including:
 assistance in access to health services,
 agreeing and guarding medical appointments, diagnostic tests,
 assistance in buying medications at the pharmacy,
 guarding medication and observing the possible side effects,
 in particularly justified cases, change bandages, help to use aids
and medical materials, orthopedic devices, and in the hygiene,
 assistance in reaching health facilities,
 assistance in reaching rehabilitation centers.
b) physical rehabilitation and improvement of disturbed body
functions in areas not covered by the Act of 27 August 2004. on
health care services financed from public funds (Dz. U. No 210,
item. 2135, as amended.)
Community-based carer, assistant to a disabled person, a nurse,
elderly carer, carer in the social assistance home, carer in the social
welfare center, a person who completed training in first aid or
medical aid
Social worker, psychologist, pedagogue, speech therapist,
occupational therapist, a specialist in the field of medical
rehabilitation, physical therapist
Part IV- Thematic workshops & working
groups
 Long-term care
 Palliative and hospice care
 Mental health
 Geriatrics
 Questions?
Thank you for your attention!
[email protected]
[email protected]