H.L.G.R. Nies

The Emerging Identity of Long-Term Care Systems in Europe

Long-term care is a concept everybody is familiar with because we read about it in the newspapers or because we know someone who receives services or works in long-term care (LTC). Nowadays it affects the lives of many people. But what is LTC exactly? Which organisations and people provide this care? Many people still associate LTC primarily with care in residential homes, but it is much more than that.

The quest for quality in long-term care

Developing and ensuring the quality of its products and services has become an imperative task for any organisation’s management. This understanding first developed in industrial settings, rather than in health and social services, where the traditional approach has been to consider quality assurance as an intrinsic part of professional ethics (Evers et al., 1997). With the increasingly market-oriented provision of health and social services, however, different stakeholders have driven forward an agenda towards the development of methods to systematically describe and improve performance of personal services, first in the area of health care and, latterly, in social and long-term care (LTC) organisations (Blonski, 1999). Public purchasers of services started to question what kind of product they were funding (‘value for money’) and how to regulate market access for different types of providers. Providers, in turn, had to verify their performance in a more transparent way to satisfy accreditation guidelines and tender specifications in a progressively competitive environment. Service providers have also viewed quality management as a way to improve organisational effectiveness in the delivery of care. Further imperatives came from inspectorates, which were established to monitor the quality and safety of the care delivery process to assure a basic level of quality. Finally, service users have voiced changing expectations concerning the quality of care.

Service integration across sectors in Europe: Literature and practice

Introduction: To meet the needs of vulnerable people, the integration of services across different sectors is important. This paper presents a preliminary review of service integration across sectors in Europe. Examples of service integration between social services, health, employment and/or education were studied. A further aim of the study was to improve conceptual clarity regarding service integration across sectors, using Minkman’s Developmental Model for Integrated Care (DMIC) as an analytical framework. Methods: The study methods comprised a literature review (34 articles) and a survey of practice examples across Europe (44 practices). This paper is based on a more comprehensive study published in 2016. Results: The study demonstrates that although the focus of integration across sectors is often on social services and health care, other arrangements are also frequently in place. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Although systems to monitor and evaluate social service integration are often present, they are not yet fully developed. The study also highlights the importance of good leadership and organizational support in integrated service delivery. Discussion: The study shows that the DMIC can work as a conceptual framework for the analysis of service integration across sectors. However, as this is an exploratory study, further in-depth case studies are required to deepen our understanding of the processes involved in service integration across sectors.

Making sense of differences-the mixed economy of funding and delivering long-term care

On average citizens of European Union (EU) countries that reach the age of 65 can expect to live for another 19.1 years and at the EU level this group of people represent 16.6 per cent of the population (Eurostat). This testifies to the current ageing profile of the European population. Although gains in life expectancy are a positive outcome in itself, not all of these years will be spent in good health or without physical limitations, which means that the need for care may arise at some point. Ageing could thus increase the demand for care, since at the population level old-age is usually associated with poorer health conditions. But as far as long-term care (LTC) systems are concerned, ageing could also reduce the availability of carers of working age. As a consequence, the pool of informal carers could be diminished, unless the reduction is compensated by informal care provided by older people, and in turn shrink the labour force available to work in the formal care sector.

Consensus-based cross-European recommendations for the identification, measurement and valuation of costs in health economic evaluations: a European Delphi study

ObjectivesDifferences between country-specific guidelines for economic evaluations complicate the execution of international economic evaluations. The aim of this study was to develop cross-European recommendations for the identification, measurement and valuation of resource use and lost productivity in economic evaluations using a Delphi procedure.MethodsA comprehensive literature search was conducted to identify European guidelines on the execution of economic evaluations or costing studies as part of economic evaluations. Guideline recommendations were extracted by two independent reviewers and formed the basis for the first round of the Delphi study, which was conducted among European health economic experts. During three written rounds, consensus (agreement of 67% or higher) was sought on items concerning the identification, measurement and valuation of costs.ResultsRecommendations from 18 guidelines were extracted. Consensus among 26 panellists from 17 European countries was reached on 61 of 68 items. The recommendations from the Delphi study are to adopt a societal perspective, to use patient report for measuring resource use and lost productivity, to value both constructs with use of country-specific standardized/unit costs and to use country-specific discounting rates.ConclusionThis study provides consensus-based cross-European recommendations on how to measure and value resource use and lost productivity in economic evaluations. These recommendations are expected to support researchers, healthcare professionals, and policymakers in executing and appraising economic evaluations performed in international contexts.

Integrated care for frail older people suffering from dementia and multimorbidity

Due to improved living conditions and better health care, life expectancy is expanding very rapidly in many countries (Colombo et al., Help wanted? Providing and paying for long-term care, OECD Health Policy Studies, Paris, 2011). Overall, we consider this as a blessing. But this blessing is to some extent ambiguous. Many people also extend their life with years in which they suffer from multiple chronic diseases, such as dementia, disabilities or frailty.

Wie is de mantelzorger

SamenvattingIn de zorg krijgt de mantelzorger een steeds prominentere rol in het beleid. Er wordt nu en in de toekomst veel van haar of hem verwacht. Tegelijkertijd blijkt in de zorgpraktijk dat er over en weer tussen cliënt, zorgverlener en mantelzorger soms tegenstrijdige verwachtingen zijn.

Nóg langer thuis wonen als gezamenlijke opgave

SamenvattingAls het om ‘langer thuis’ gaat is er eigenlijk niets nieuws onder de zon. We zijn er al zo’n 45 jaar mee bezig! Toch lijkt nu een grotere druk op dit beleidsdoel te liggen dan ooit. Veel van die urgentie heeft te maken met de betaalbaarheid van de zorg; uit de collectieve middelen wel te verstaan. Maar zeer veel ouderen kiezen sowieso voor langer thuis, of dat nu in beleidsnota’s staat of niet. In die zin is het huidige beleid in lijn met de maatschappelijke ontwikkelingen. Maar wat zijn de voorwaarden om dit beleidsdoel en deze maatschappelijke trend naar nóg langer thuis wonen goed voor elkaar te krijgen?

Improving Policy and Practice in Long-Term Care

When Peter Townsend published his landmark study about long-stay institutional care in England and Wales 50 years ago, he could not help calling these institutions ‘The Last Refuge’ (Townsend, 1962). He was ‘both daunted and shocked’ by what he had seen and heard, from overcrowded dormitories ‘with ten or twenty iron-framed beds close together’ (p. 4). He noticed ‘isolated persons sitting alone in a wash-room, standing in a corridor and one looking out of a staircase window weeping silently’ and he found heavily restricted privacy together with authoritarian matrons in uniforms and inappropriate staffing (p. 5f.). A ‘revisiting study’ by Johnson et al. (2010) found that 37 out of the 173 care homes visited by Townsend in the late 1950s were still providing long-term care (LTC) for older people. Results for the 20 homes that were sampled for revisiting revealed that: (…) residential care for older people, insofar as it is now catering for an older and more infirm population has been transformed into a radically different instrument of social policy when compared to the 1950s (…) While the physical environment may have improved, we recorded many institutional features which appear to characterise the twenty-first century care home. These features reflect not only the changed function of residential care but also an increasing concern with risk and safety. (Johnson et al., 2010, p. 209f.)