5.8 Long-term care

At present, health care and social care are not well coordinated for people requiring long-term care. Long-term care lacks integrated home care, community, ambulatory or hospital health and social services. Both social and health care are subject to different legal frameworks and their competences fall into two different sectors. Social care aims to reduce or overcome social deprivation, prevent mental, physical and social developmental disorders, and ensure underprivileged people full participation in society. Social care is funded from the state budget, the budget of the self-governing regions and the municipal budgets. Nursing care becomes part of the long-term care system if people are eligible for such services for a period of more than six months. Health care services provided within long-term care are mostly covered by SHI or by direct payments from clients. Fig. 5.6 provides an overview of the various services provided under long-term care and its financing.

Fig. 5.6: Long-term care financing

Ambulatory care for elderly people is provided in both general and specialized health care facilities. General health care for geriatric patients is provided in GP practices or by home care nursing agencies. Nursing care includes preventive activities through educational and counselling activities.

Both health and social services are provided in long-term outpatient care. Outpatient health services are provided in general and specialized outpatient departments, home care nursing agencies and day-care centres.

Specialized ambulatory care is provided to geriatric patients in geriatric outpatient departments or other specialized outpatient departments, including care for patients with incontinence, immobility and dementia. Ambulatory care for geriatric patients with psychiatric conditions is provided in geriatric psychiatric outpatient departments and day-care centres.

Agencies for nursing care services primarily provide nursing and rehabilitation care at home. Home care is provided as a continuation of inpatient care upon discharge from a hospital and for people with acute and chronic conditions not requiring hospitalization. The amount of reimbursement depends on the fees for procedures. Some of these agencies also provide attendance care (for example bathing, dressing and eating) but this type of care is not covered by SHI. In 2008, there were 127 agencies for nursing care services.

Most residential health care units focus on psychiatry and provide many different treatments (for example, occupational therapy, group therapy, individual psychotherapy). Typical examples are day-care centres for chronic patients such as addicts (drug, gambling, and alcohol addiction) and geriatric patients (psychiatric disorders or dementia). The services are covered by health insurance per one-day stay, provided the centre has a contract with a health insurance company. In 2008, 83 health care facilities delivered services in residential health care units with 1036 daily places for outpatients (NCHI, 2009b).

A nursing care facility may either be attached to a health care facility or may be an independent health care facility. They are financed by SHI, provided the nursing agency has a contract with a health insurance company. Health care facilities may require direct fees for services that are not covered by SHI or they may seek other resources. In 2007, only one independent nursing care facility with 33 beds was registered.

In 2004, the Ministry of Health proposed a draft bill on long-term care and long-term support aimed at the integration of people with functional restrictions. The objective of this bill was to integrate the overlapping social care and health care sectors as well as their financing. The bill, however, was opposed by NGOs as well as the Ministry of Social Affairs.