Last year, from November 15 to 16 in Paris, an expert meeting took place, which was linked to the project of the OECD Health Committee and Working Party on Social Policy on Long-Term Care and its financing (1) (OECD Health Committee and Working Party on Social Policy on LTC Workforce and Financing). Experts from the ministries of health and social affairs of OECD member states participated, along with several invited academic experts. OECD defines long-term care (hereinafter LTC(2)) as care for people, defined as a coherent range of services intended for people who are dependent on help in some basic self-care activities. People in need of LTC services are those with limited self-reliance, especially in basic self-care activities, and this condition is persistent; it can be caused either by chronic diseases, or it can be a consequence of health impairment, whether physical or mental.

The expert meeting focused on the experiences of individual countries regarding LTC workforce and financing and further on identifying knowledge issues in management and policy-priority setting. It is in the political interest to find solutions to societal and demographic changes (population aging, declining availability of informal care, increasing care demand) that have a direct impact on the labor market.

In connection with this issue, a study is being prepared within the LTC section that, within its hypotheses, addresses the following questions for subsequent society-wide resolution:

  • How to cope with rising demand for formal LTC and how to secure enough caregivers (for example, how to increase the attractiveness of these occupations and how to reduce staff turnover)?
  • Should we support caregiving families? What motivational mechanisms should be used?
  • Can the public sector afford to finance the expected rise in costs while providing adequate LTC risk coverage?
  • Do we need other funding mechanisms? What other sources can we use?
  • How can LTC systems be made more efficient?
  • What is the impact of the economic crisis on LTC financing and employment within it?

The issue of informal care in different OECD countries

Countries across OECD are dealing with the issue of informal care, since caregiving families and friends are the backbone of the LTC system. It is, however, generally understood that informal caregivers are psychologically and physically burdened by caring for their loved ones. At the meeting, policy for preventing and mitigating the undesirable consequences of informal care for caregivers was discussed. In particular, this concerns the issue of worsening mental and physical health, the poverty trap for caregivers, and the decision to leave the labor market due to the high burden of care. It is necessary to create a strategy for this group of informal caregivers based on blended care (shared care distributed between informal and professional caregivers), which can help combine a work career with caregiving. Preventive measures are urgently needed for this group, as they help improve caregivers’ health and mental well-being. In this matter, flexible work arrangements need to be created for informal caregivers, allowing them to better reconcile working life and their caregiving role. The role of respite care and the provision of essential information and coordination of social and health care is indisputable.

Experiences from Belgium Representative from Belgium, Mireille Goemans of the Federal Public Service Social Security, presented access systems to LTC in Belgium. In the Walloon region, emphasis is placed on household/home services, and unlike in the Flemish community, fewer people are placed in institutions. At the federal level, no special strategy in LTC has been created, but there are initiatives funded by health insurance—these are respite care (day centres, short-term stays) and alternative care (a new initiative, mainly supporting care in a home environment). This country, however, has created a strategy to support family caregivers, which consists of a monthly care allowance and protection from dismissal from work if they care for a family member; this enables them to return to the labor market after care ends. Caregivers also have entitlement to social security. In the area of informal care, a study—“Legal recognition and access to social rights for informal carers” (online: http://www.aidants-proches.be/rshared/File/reconnaissance-legale-des-aidants-proches.pdf - PDF)—was developed, dealing with the new definition of the caregiver role (who actually is the close person) and with securing adequate support and legal and social protection for this person. In the future, it will be necessary to create a legal, tax and social status for the informal caregiver. These measures will lead to recognition of their social security rights, since this is work, and recognition of the knowledge and skills gained in care for further integration into the labor market.

Experiences from Norway In Norway, this care is ensured through communities. There is very close collaboration between communities and families. For this purpose, the government of the Kingdom of Norway (in 2006) adopted in parliament a resolution on the LTC preparatory plan to 2015. The need for LTC is an increasingly growing problem, so it will not be possible for the health and social care sector alone to address it; society-wide measures are required.

The government approved LTC as a future challenge and defined five key areas to address, which are reflected in the care strategy to 2015:

The first area deals with identifying new population groups that will require LTC services.

The second area is demographic change in society, which will require not only increasing the volume of care provided but also deepening the knowledge of caregiving professions regarding LTC. Aging of the population cannot be seen only as a problem; it is also necessary to consider that the next generation of seniors will include people in better health and also people who will be wealthier than the previous generation. These people will have greater demands, for example, on the quality of services provided.

The third area is the future shortage of caregivers, which is related to increasing life expectancy.

The fourth area is the need for increased medical oversight and monitoring, when it is beyond doubt that the need for specialized medical and multidisciplinary professional support in both home-based LTC and institutional settings will also grow. This especially concerns patients with complex health needs, but also for example people with dementia and other psychiatric and neurological syndromes affecting mental health and cognitive function who need a coordinated range of services, starting with specialized health services and ending with services in the community.

The fifth area is adequately meeting the psychosocial needs of people requiring LTC, as LTC is too focused on the health and social aspects of care. Meeting psychosocial needs requires the involvement of a broader range of professional workers so that greater emphasis can be placed also on psychological aspects of care and meaningful activities. Strategies to 2015 were created from these problem areas; they do not represent revolutionary changes in the system, but a gradual development of LTC. Core strategies include:

  • Promotion of quality, research and planning—the development of LTC in Norway will require both investment in adapting facilities to the needs of people with long-term illness and investment in education and development of human resources. In Norway, LTC is viewed as an activity that communities should provide.
  • Increased capacity through strengthening capabilities and knowledge.
  • Better coordination with the health sector and patient monitoring.
  • An active approach to care.
  • A quality agreement—the government has agreed with professional organisations that service provision will give sufficient attention to quality, which will be based mainly on multidisciplinary cooperation, improvement of multidisciplinary team skills, and better planning and organization of care at both community level and for individual clients.

Other parts of this plan’s strategy are strengthening management and better organization of services. Services at community level should be able to respond flexibly to demands and needs of LTC recipients in individual communities. Modern technologies are also tools for better service organization.

Conclusion

LTC is a highly debated issue in European countries within healthcare systems. These systems will have to deal with population aging and securing health and social care, creating new professions in LTC according to the specific problems of an aging population. According to experts in this field, about one million healthcare workers will be lacking by 2020, and about 15% of healthcare will not be fully covered. However, there will also be a shortage of 2 million workers in LTC, which will lead to 15% not being covered even in this sector. These results are very serious. It is necessary to map future health needs and help member states in planning human resources in this area. It is also necessary to map current workforce competencies and knowledge and adjust them according to future needs. It is necessary to increase the attractiveness of healthcare occupations by improving working conditions. It is also necessary to resolve migration issues. New skills for new jobs are part of the “Europe 2020” strategy. There is a need for a skilled workforce and also educational institutions that will respond flexibly to these needs. Flagship initiatives in this area are “An agenda for new skills and new jobs” and “Youth on the move.” Another step for the European Commission will be the creation of a workforce action plan, a joint action on workforce modelling and forecasting, and the use of European educational funds.

Mgr. Monika Válková doc. MUDr. Iva Holmerová, Ph.D. Mgr. Tomáš Roubal (editorially revised) Sources: OECD EXPERT MEETING ON LONG-TERM CARE: How to support family carers?,15-16 November 2010, Paris

(1) Organisation for Economic Co-operation and Development (editor's note) (2) From English long-term care (editor's note)

More information can be obtained on the websites http://www.socialnisluzby.eu and http://www.apsscr.cz.