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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 → → → → → → → → → → 7 7 5 3 2 2 2 1 1 1 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]