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Long-term care in the Netherlands <ul><li>Ingrid Blok </li></ul><ul><li>Directorate Long-term care </li></ul><ul><li>April...
荷蘭的長期照顧 <ul><li>Ingrid Blok </li></ul><ul><li>長期照顧主任 </li></ul><ul><li>04 .2010 </li></ul>
Long-term care <ul><li>Health Insurance Act </li></ul><ul><li>Exceptional Medical Expenses Act </li></ul><ul><li>Social Su...
長期照顧 <ul><li>健康保險法案 ( Health Insurance Act ) </li></ul><ul><li>特別醫療支出法案 ( Exceptional Medical Expenses Act ) </li></ul><ul...
Demographic key figures in the Netherlands <ul><li>Population 2006: 17 mln. </li></ul><ul><li>Inhabitants p/km2: 484 </li>...
荷蘭人口主要資料 <ul><li>2006 年底人口數 : 一千七百萬 . </li></ul><ul><li>人口密度   :   484 人 / 平方公尺 </li></ul><ul><li>家庭戶數 :   七百一十萬     2.3p...
<ul><li>CURE </li></ul><ul><li>Health  </li></ul><ul><li>Insurance </li></ul><ul><li>Act </li></ul><ul><li>HIA </li></ul>C...
<ul><li>治療 </li></ul><ul><li>健康保險法案 </li></ul><ul><li>HIA </li></ul>照顧 特別醫療 支出法案 EMEA 社會支持法案 SSA
Health Insurance Act <ul><li>Since 1 January 2006. </li></ul><ul><li>For residents over 18 years.  </li></ul><ul><li>Appro...
健康保險法案 (Health Insurance Act) <ul><li>自 2006 年一月一日起 </li></ul><ul><li>針對 18 歲以上的居民  </li></ul><ul><li>大約有 40 家私人保險業者 </li>...
Health Insurance Act <ul><li>Basic insurance </li></ul><ul><li>Covers the cost of primary health care: e.g. general practi...
健康保險法案 (Health Insurance Act) <ul><li>基本保險 (Basic insurance) </li></ul><ul><li>包含主要的健康照顧費用 :  如一般醫療 ,  住院醫療照顧 </li></ul><u...
Health Insurance Act <ul><li>Additional insurance packages </li></ul><ul><li>Financed: 100% by client.  </li></ul><ul><li>...
健康保險法案 (Health Insurance Act) <ul><li>額外配套保險 (Additional insurance packages) </li></ul><ul><li>費用 : 100% 由顧客支付  </li></ul>...
Exceptional Medical Insurance Act <ul><li>(Mandatory) public long term care  insurance. </li></ul><ul><li>Financing: perce...
特別醫療支出法案 (Exceptional Medical Insurance Act) <ul><li>( 強制性的 )   公共長期照顧保險 </li></ul><ul><li>經費來源 :  收入   ( 税 ) 的比例 </li></u...
Long-term Care in historic perspective 1968 1998  2008 Costs EMEA-care 1  (billion €’s) < € 1 €  12.8 €  20.5 Number of cl...
長期照顧的歷史演進 1968 1998  2008 成本 EMEA-care 1  ( 以兆 歐元計 ) <  €  1 €   12.8 €   20.5 顧客數 約  55,000 約 900,000 約 500,000 (excl. GG...
Clients in long-term care   335,000 253,000 558,000 TOTAL 61,000 23,000 84,000 Clients with psychiatric problems 47,000 66...
長期照顧的顧客數 335,000 253,000 558,000 總計 61,000 23,000 84,000 精神障礙者 47,000 66,000 113,000 障礙者 - 心智 - 肢體  ( 包含視障 / 聽障 )  210,000...
Assessment office Client Insurance company/ Health care office Care provider Organisational   structure
評估部門 顧客 保險公司 / 健康照顧部門 照顧提供者 組織架構
Organisations EMEA-care <ul><ul><li>Regional Assessment Offices are in charge for the assessment of clients (entering EMEA...
EMEA- 照顧的組織 <ul><ul><li>地方評估部門負責顧客進入 EMEA 的評估 ,  決定照顧的額度以及給顧客一個照顧指標 </li></ul></ul><ul><ul><li>健康照顧部門與照顧提供者訂有合約 .  健康照顧部門需...
Assessment <ul><li>The regional Assessment Offices screens applications. </li></ul><ul><li>Home visits (for assessment) or...
評估 <ul><li>地方評估部門對申請者進行篩檢審核 </li></ul><ul><li>家訪   ( 為了評估 )   或電訪 ( 主要是為了再次評估 )   來決定照顧的額度 .  會依每個顧客的個別情況而定 . </li></ul><u...
Assessmentfunnel Client Medical diagnosis/disease/function disorders Disabilities / participation problems Environment Exi...
評估流程 顧客 醫療診斷 / 疾病 / 功能障礙 障礙  /  參與的問題 環境 現有的設施 1. 個人在其環境的 “圖像 ” 治療處遇 ,  重健 ,  教育 ,  適應調整 由同住者提供“一般”照顧 其他法律 / 法規相關規定 一般可使用的...
Care functions for care in kind <ul><li>Personal care, such as help with everyday activities. </li></ul><ul><li>Nursing, s...
實務照顧的功能 <ul><li>個人照顧 ,  如每日活動的協助 . </li></ul><ul><li>看護 ,  如協助服藥 ,  更衣或呼吸照顧 .  </li></ul><ul><li>支持 ,  如學習克服障礙或問題 ,  個人功能更...
Accomodation <ul><li>Care level packages for intramural care: for the elderly (somatic and psychogeriatric [eg dementia]),...
住宿 ( Accommodation ) <ul><li>地區照顧層級配套組合 :  針對老人  ( 有身心需求者  [ 如失智症 ]), 肢體障礙 ,  感官障礙  ( 視覺 ,  聽覺 ,  溝通 ),  心智障礙 ,  輕度心智障礙青年以...
Examples care level package <ul><li>VV package 1: Sheltered living with little support </li></ul><ul><li>Client can do dai...
照顧配套層級範例 <ul><li>VV  套組層級 1:  少量支持的庇護性居住 </li></ul><ul><li>顧客可自行從事日常活動 ,  但有時需要提醒某些事 .  </li></ul><ul><li>顧客有時會覺得自己一個人 ,  ...
Examples care level package <ul><li>LVG youth package 1:  </li></ul><ul><li>Youngster lives as independently as possible (...
照顧配套層級範例 <ul><li>LVG  青少年 套組層級 1:  </li></ul><ul><li>青少年盡可能的可以獨立生活  ( 如 . 在團體家庭 ),  但需要支持與某些形式的治療 . </li></ul><ul><li>支持的目...
You have a care indication, what next? <ul><li>You decide, which care provider you want to go to.  </li></ul><ul><li>If th...
當你有了照顧指標 ,  接下來呢 ? <ul><li>你決定選擇哪個照顧提供者 .  </li></ul><ul><li>如果有名額 ,  你可以申請並住在那裡 , 且 / 或接受你需要的照顧 .  在照顧計畫中會明列照顧指標  ( 顧客與照顧...
Care functions for Personal care budget <ul><li>Personal care, such as help with everyday activities.  </li></ul><ul><li>N...
個人照顧預算的功能 <ul><li>個人照顧 ,  如日常活動的協助 .  </li></ul><ul><li>看護 ,  如協助服藥 . </li></ul><ul><li>支持協助 ,  支持室內 / 外的活動 ,  如日間照顧或學習克服障...
Assessment <ul><li>The first steps are the same as for care in kind: Regional Assessment Office determines how much care i...
評估 <ul><li>所有照顧類型的第一步驟皆相同 :  由地方評估部門決定需要的照顧額度 ,   並給照顧指標 . </li></ul><ul><li>在實務照顧與個人照顧預算 (PCB) 間做選擇 .   平均而言 , 個人照顧預算佔實務照...
Personal care budget <ul><li>Client purchases on her/his own the care needed as well as the paperwork (accounts e.g.). </l...
個人照顧預算 (Personal care budget) <ul><li>顧客購買自己所需的照顧與文書工作  ( 如帳戶 ). </li></ul><ul><li>顧客購買自己所需的照顧 ,  但文書工作外包給例如社會服務 (Social P...
Who chooses for PCB? <ul><li>Disabilities: </li></ul><ul><li>50% people with physical problems.  </li></ul><ul><li>20% dis...
誰選擇使用個人照顧預算 ( PCB ) ? <ul><li>障礙者 : </li></ul><ul><li>50%  是肢體障礙者 .  </li></ul><ul><li>20%  障礙人士 . </li></ul><ul><li>30%  ...
Fraud <ul><li>Reports have emerged concerning the fraudulent use of PCB.  </li></ul><ul><li>From 1 July 2009 the PCB can o...
舞弊 <ul><li>開始有報告關注使用個人照顧預算引起的舞弊 .  </li></ul><ul><li>從 2009 年 7 月 1 日起 , 個人照顧預算只能支付到成年的預算持有人帳戶或是他們法定代理人的帳戶 . </li></ul><ul...
Facts <ul><li>Average budget:  € 16,500 per year </li></ul><ul><li>Maximum budget: € 300 per  day  / over € 100,000 per ye...
事實 <ul><li>平均預算 :  每年  16,500  歐元 </li></ul><ul><li>最高預算 : 每天  300  歐元  /  每年超過  100,000 歐元  </li></ul><ul><li><  每年  50,0...
Number of PCB users 1.845 109.000 2008 1.455 90.000 2007 1.136 95.000 2006 922 78.000 2005 726 70.000 2004 651 63.000 2003...
PCB 的使用人數 1.845 109.000 2008 1.455 90.000 2007 1.136 95.000 2006 922 78.000 2005 726 70.000 2004 651 63.000 2003 413 48.00...
Way of supply Target groups Care in kind Personal budgets Both Demented elderly people  Elderly people with physical/somat...
輸送方法 目標族群 實務照顧 個人預算 兩者 失智老人   身心障礙老人 障礙者 精神障礙者 70.000 295.000 85.000 50.000 1.000 19.000 19.000 32.000 1.000 5.000 9.000 2...
Costs €  14,500 €  1.3 Personal budget €  58,500 €  22,000 €  14.8  €  5.9 <ul><li>Care in kind: </li></ul><ul><li>institu...
費用 €  14,500 €  1.3 個人預算 €  58,500 €  22,000 €  14.8  €  5.9 <ul><li>實務照顧 : </li></ul><ul><li>機構 (institution) </li></ul><...
Other organisations (long-term care field) <ul><li>ZN: is the sector organisation of the private health insurers as well a...
其他組織  ( 長期照顧領域 ) <ul><li>ZN: 是私立區域性的健康保險業組織 ,  同時也是健康照顧服務部門 . </li></ul><ul><li>CAK:  計算並收集顧客的自擔風險 / 費用捐助 ; 需負責支付費用給 EMEA ...
Ageing (a global perspective)   <ul><li>%65+       %growth </li></ul><ul><li>2005 2030 2005-2030 </li></ul><ul><li>Netherl...
老化  ( 全球觀點 )   <ul><li>65 歲以上 %      成長 % </li></ul><ul><li>2005 2030 2005-2030 </li></ul><ul><li>荷蘭  14.1% 22.3%     58% ...
Developments / challenges <ul><li>Sustainability of the long term care, also in relation to </li></ul><ul><li>growing popu...
發展  / 挑戰 <ul><li>長期照顧的支撐能力 ,  </li></ul><ul><li>65 歲以上老人人口持續成長 . </li></ul><ul><li>照顧服務產業勞力能力的短缺 . </li></ul><ul><ul><li>對...
Social Support Act <ul><li>The Social Support Act (SSA) is in force from 1 January 2007. </li></ul><ul><li>Municipalities ...
社會支持法案 (Social Support Act) <ul><li>自 2007 年 1 月 1 日起強制施行社會支持法案  (SSA). </li></ul><ul><li>由地方負責執行 . 部會定義體制架構 ,  各地方可依所組成的居...
Entrance to the Social Support Act <ul><li>Assessment either by the SSA-unit of the regional Assessment Office (since 2008...
進入社會支持法案 <ul><li>可由地方評估部門的社會支持法案 - 單位 ( 自 2008 年開始運作 ) 進行評估 ,  或是由市府進行評估 . </li></ul><ul><li>集體或個人 . </li></ul><ul><li>實務照...
Municipality are in charge for <ul><li>Neighbourhood well being & civic society. </li></ul><ul><li>Provisions for disabled...
市府負責 <ul><li>鄰里福祉 &  公民社會 . </li></ul><ul><li>為障礙者提供服務如輪椅 ,  住屋調整改善 ,  調整改善   ( 大眾 ) 交通 . </li></ul><ul><li>居家照顧 ;  家務照顧 ....
Nine performance fields (1) <ul><li>1 °. The promotion of social cohesion and quality of life in villages, districts and  ...
九項表現領域 (1) <ul><li>1 °.  推動鄰里 、 鄉鎮等地區對生活品質的社會凝聚力 . </li></ul><ul><li>2°.  將預防焦點放在青少年父母扶養小孩所面臨的問題 . </li></ul><ul><li>3°.  ...
5°. The promotion of participation in society and the independent functioning of people with a disability or chronic menta...
5°. 推動障礙者或慢性精神障者或有心理障礙者參與社會與獨立能力 . <ul><li>6°.  提供障礙者或慢性精神障礙者或心理障礙者所需的服務 . </li></ul><ul><li>7°.  提供社會救濟 ,  包含婦女庇護與尋求對抗家暴政...
How ‘non-committal’ is the municipality? <ul><li>Very free </li></ul><ul><li>Freedom of policy about allocation, awarding,...
How  ‘non-committal’  is the municipality? <ul><li>非常自由 </li></ul><ul><li>資源分配 、 獎勵與補助政策的 自由 . </li></ul><ul><li>不須對國家政府報告...
Compensation principle <ul><li>To compensate for the limitations experienced by a person in his ability to live independen...
補助原則 <ul><li>為了補助因障礙而限制其獨立生活與參與社會的經驗 ,  市府應提供措施來協助他 : </li></ul><ul><li>經營一個家 ; </li></ul><ul><li>能在住家內與四周移行 ; </li></ul><...
Better home in the neighbourhood <ul><li>Programme by the Ministry of Health, Welfare and Sports and the Ministry of Housi...
在鄰里有更好的家 <ul><li>由健康福利與運動部門與居住部門共同提出的方案 . </li></ul><ul><li>住宅–福利–照顧設施的連鎖 . </li></ul><ul><li>推廣多樣化的住宅與照顧 . </li></ul><ul>...
Government measures to housing <ul><li>Private initiaves for small scaled housing for the elderly with a need for care (ph...
政府的住宅措施 <ul><li>私立單位倡議為有需要的老人提供小型住宅  ( 身體或心理  [ 如失智症 ]). </li></ul><ul><li>完成在家照顧的配套  ( 在自己的家 ) (‘VPT’; EMEA). </li></ul><...
Government measures to housing <ul><li>Residential care (EMEA) </li></ul><ul><li>Nursing homes: financial   investments to...
政府的住宅措施 <ul><li>住宅照顧  (EMEA) </li></ul><ul><li>護理之家 :  經濟投資 , 將多人房改為單人房 ( 隱私 ) </li></ul><ul><li>障礙服務機構 :  經濟投資 , 改善房間狀況  ...
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荷蘭的長期照顧(中英對照版)

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發表於2010年4月荷蘭社會福利暨社會住宅研討會
主辦單位:瑪利亞基金會
協辦單位:社區居住聯盟

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Transcript of "荷蘭的長期照顧(中英對照版)"

  1. 1. Long-term care in the Netherlands <ul><li>Ingrid Blok </li></ul><ul><li>Directorate Long-term care </li></ul><ul><li>April 2010 </li></ul>
  2. 2. 荷蘭的長期照顧 <ul><li>Ingrid Blok </li></ul><ul><li>長期照顧主任 </li></ul><ul><li>04 .2010 </li></ul>
  3. 3. Long-term care <ul><li>Health Insurance Act </li></ul><ul><li>Exceptional Medical Expenses Act </li></ul><ul><li>Social Support Act </li></ul><ul><li>Government measures to housing </li></ul>
  4. 4. 長期照顧 <ul><li>健康保險法案 ( Health Insurance Act ) </li></ul><ul><li>特別醫療支出法案 ( Exceptional Medical Expenses Act ) </li></ul><ul><li>社會支持法案 ( Social Support Act ) </li></ul><ul><li>政府對住宅的措施 (Government measures to housing) </li></ul>
  5. 5. Demographic key figures in the Netherlands <ul><li>Population 2006: 17 mln. </li></ul><ul><li>Inhabitants p/km2: 484 </li></ul><ul><li>Households: 7.1 mln  2.3pp/h </li></ul><ul><li>GDP per capita: 36,000 us$ </li></ul><ul><li>Life expectancy: 78.6 year </li></ul><ul><li>Fertility rate: 1.76 </li></ul>
  6. 6. 荷蘭人口主要資料 <ul><li>2006 年底人口數 : 一千七百萬 . </li></ul><ul><li>人口密度 : 484 人 / 平方公尺 </li></ul><ul><li>家庭戶數 : 七百一十萬  2.3pp/h </li></ul><ul><li>平均 GDP: US$ 36,000 </li></ul><ul><li>平均壽命 : 78.6 歲 </li></ul><ul><li>生育力 : 1.76 </li></ul>
  7. 7. <ul><li>CURE </li></ul><ul><li>Health </li></ul><ul><li>Insurance </li></ul><ul><li>Act </li></ul><ul><li>HIA </li></ul>CARE Exceptional Medical Expenses Act EMEA SOCIAL SUPPORT ACT SSA
  8. 8. <ul><li>治療 </li></ul><ul><li>健康保險法案 </li></ul><ul><li>HIA </li></ul>照顧 特別醫療 支出法案 EMEA 社會支持法案 SSA
  9. 9. Health Insurance Act <ul><li>Since 1 January 2006. </li></ul><ul><li>For residents over 18 years. </li></ul><ul><li>Approx. 40 private health insurers. </li></ul><ul><li>Basic insurance (mandatory) and additional insurance packages (voluntarily). </li></ul><ul><li>Possibility to change insurer at the beginning of every year. </li></ul><ul><li>Own risk. </li></ul><ul><li>Compensation e.g. chronically ill and disabled. </li></ul><ul><li>Financing on basis of combinations of diagnosis and treatment. </li></ul>
  10. 10. 健康保險法案 (Health Insurance Act) <ul><li>自 2006 年一月一日起 </li></ul><ul><li>針對 18 歲以上的居民 </li></ul><ul><li>大約有 40 家私人保險業者 </li></ul><ul><li>基本保險 ( 強制性的 ) 以及額外配套保險 ( 自由選擇 ) </li></ul><ul><li>在每年年初可改變保險單位 </li></ul><ul><li>自擔風險 (Own risk) </li></ul><ul><li>補償例如慢性病與障礙者 </li></ul><ul><li>結合診斷與處遇作為補助基礎 </li></ul>
  11. 11. Health Insurance Act <ul><li>Basic insurance </li></ul><ul><li>Covers the cost of primary health care: e.g. general practitioners, hospital care. </li></ul><ul><li>The insured pay a nominal premium to the health insurer plus an income-related contribution for employees (income tax). </li></ul><ul><li>Client chooses health insurer. </li></ul><ul><li>Health insurers are obliged to accept all clients. </li></ul>
  12. 12. 健康保險法案 (Health Insurance Act) <ul><li>基本保險 (Basic insurance) </li></ul><ul><li>包含主要的健康照顧費用 : 如一般醫療 , 住院醫療照顧 </li></ul><ul><li>被保險人象徵性支付保險業者健保費 , 加上跟受雇者收入相關的補助 ( 所得稅 ) </li></ul><ul><li>由客戶選擇健保業者 </li></ul><ul><li>健保業者有義務要接受任何人的承保 </li></ul>
  13. 13. Health Insurance Act <ul><li>Additional insurance packages </li></ul><ul><li>Financed: 100% by client. </li></ul><ul><li>Each health insurer has a number of different additional packages. </li></ul><ul><li>Client chooses package and/or health insurer. </li></ul><ul><li>Can be another health insurer than insurer where basic insurance is closed. </li></ul>
  14. 14. 健康保險法案 (Health Insurance Act) <ul><li>額外配套保險 (Additional insurance packages) </li></ul><ul><li>費用 : 100% 由顧客支付 </li></ul><ul><li>每位健保業者都有不同的額外配套保險 . </li></ul><ul><li>顧客可自選擇配套保險以及 / 或健保業者 </li></ul><ul><li>額外配套保險跟基礎保險可以是不同家 , 可以是另外一家業者 </li></ul>
  15. 15. Exceptional Medical Insurance Act <ul><li>(Mandatory) public long term care insurance. </li></ul><ul><li>Financing: percentage of income (tax). </li></ul><ul><li>F or frail elderly, disabled people and people with chronic psychiatric disorders. </li></ul><ul><li>Both in residential care (such as nursing homes and elderly homes) as well as home care. </li></ul><ul><li>Care in kind and Personal care budget. </li></ul><ul><li>Own risk / contribution to costs. </li></ul><ul><li>Since 1968. </li></ul>
  16. 16. 特別醫療支出法案 (Exceptional Medical Insurance Act) <ul><li>( 強制性的 ) 公共長期照顧保險 </li></ul><ul><li>經費來源 : 收入 ( 税 ) 的比例 </li></ul><ul><li>針對弱勢老人 , 障礙者以及慢性精神障礙者 </li></ul><ul><li>同時適用於住宿照顧 ( 例如護理之家與老人之家 ) , 以及居家照顧 </li></ul><ul><li>實務照顧 (care in kind) 以及個人照顧預算 (personal care budget) </li></ul><ul><li>自擔風險 (Own risk) / 費用捐助 (contribution to costs). </li></ul><ul><li>自 1968 年開始 </li></ul>
  17. 17. Long-term Care in historic perspective 1968 1998 2008 Costs EMEA-care 1 (billion €’s) < € 1 € 12.8 € 20.5 Number of clients about 55,000 about 900,000 about 500,000 (excl. GGZ-extramural) about 600,000 Premium EMEA 0.41 % 9.60% 12.15%
  18. 18. 長期照顧的歷史演進 1968 1998 2008 成本 EMEA-care 1 ( 以兆 歐元計 ) < € 1 € 12.8 € 20.5 顧客數 約 55,000 約 900,000 約 500,000 (excl. GGZ-extramural) 約 600,000 EMEA 補助 0.41 % 9.60% 12.15%
  19. 19. Clients in long-term care 335,000 253,000 558,000 TOTAL 61,000 23,000 84,000 Clients with psychiatric problems 47,000 66,000 113,000 Disabled -mentally -physically (incl. blindness/deafness) 210,000 109,000 319,000 Elderly with physical problems 17,000 55,000 72,000 Dementia Home care Institutions Volume Clients
  20. 20. 長期照顧的顧客數 335,000 253,000 558,000 總計 61,000 23,000 84,000 精神障礙者 47,000 66,000 113,000 障礙者 - 心智 - 肢體 ( 包含視障 / 聽障 ) 210,000 109,000 319,000 有肢體問題的老人 17,000 55,000 72,000 失智症 居家照顧 機構式 額度 顧客
  21. 21. Assessment office Client Insurance company/ Health care office Care provider Organisational structure
  22. 22. 評估部門 顧客 保險公司 / 健康照顧部門 照顧提供者 組織架構
  23. 23. Organisations EMEA-care <ul><ul><li>Regional Assessment Offices are in charge for the assessment of clients (entering EMEA), determines the amount of care and give clients a care indication. </li></ul></ul><ul><ul><li>The Health Care Offices have contracts with Care Providers and finances the Care Provider. The Care Offices are responsible that clients receive care and support. </li></ul></ul><ul><ul><li>Care Providers deliver the care and support to clients. They are –by law- responsible for good quality of care and support. </li></ul></ul>
  24. 24. EMEA- 照顧的組織 <ul><ul><li>地方評估部門負責顧客進入 EMEA 的評估 , 決定照顧的額度以及給顧客一個照顧指標 </li></ul></ul><ul><ul><li>健康照顧部門與照顧提供者訂有合約 . 健康照顧部門需負責顧客獲得所需的照顧與支持 . </li></ul></ul><ul><ul><li>照顧提供者提供顧客所需的照顧與支持 . 依法他們需提供品質良好的照顧與支持 . </li></ul></ul>
  25. 25. Assessment <ul><li>The regional Assessment Offices screens applications. </li></ul><ul><li>Home visits (for assessment) or by phone (mainly for re-assessment) to determine amount of care. This depends on the individual situation of each client. </li></ul><ul><li>Validation of the care indication in general 5 years, some groups indefinitely. </li></ul><ul><li>Re-assessment also on request, when situation changes. </li></ul><ul><li>Choice for care in kind or personal care budget. </li></ul>
  26. 26. 評估 <ul><li>地方評估部門對申請者進行篩檢審核 </li></ul><ul><li>家訪 ( 為了評估 ) 或電訪 ( 主要是為了再次評估 ) 來決定照顧的額度 . 會依每個顧客的個別情況而定 . </li></ul><ul><li>一般照顧指標的有效性是 5 年 , 某些族群是不定期 . </li></ul><ul><li>當情況改變時 , 亦可申請重新評估 . </li></ul><ul><li>選擇實務照顧或個人照顧預算 . </li></ul>
  27. 27. Assessmentfunnel Client Medical diagnosis/disease/function disorders Disabilities / participation problems Environment Existing facilities 1. “Picture” of the client in his surroundings Treatment, rehabilitation, education, adaptation “ Normal” care provided by members of the same household Provisions from other laws/acts General accessible facilities 2. Gross need for care Care given by informal caregivers 3. Nett-need for care 4. Decision 5b. With accommodation 5a. Without accommodation
  28. 28. 評估流程 顧客 醫療診斷 / 疾病 / 功能障礙 障礙 / 參與的問題 環境 現有的設施 1. 個人在其環境的 “圖像 ” 治療處遇 , 重健 , 教育 , 適應調整 由同住者提供“一般”照顧 其他法律 / 法規相關規定 一般可使用的設施 2. 照顧的初步需求 由非正式照顧者提供照顧 3. 照顧的實價需求 4. 決定 5b. 需要適應調整 5a. 不需適應調整
  29. 29. Care functions for care in kind <ul><li>Personal care, such as help with everyday activities. </li></ul><ul><li>Nursing, such as help with the use of medicines, changing dressings or respiration. </li></ul><ul><li>Support, such as learning to cope with your disability or problems, to function better personally and to achieve changes. </li></ul><ul><li>Treatment, when people are using EMEA-care and need extra treatment. </li></ul><ul><li>Accommodation (living, services and care/treatment) for those who need special convenience in a setting. </li></ul>
  30. 30. 實務照顧的功能 <ul><li>個人照顧 , 如每日活動的協助 . </li></ul><ul><li>看護 , 如協助服藥 , 更衣或呼吸照顧 . </li></ul><ul><li>支持 , 如學習克服障礙或問題 , 個人功能更好以及達成改變 . </li></ul><ul><li>治療處遇 , 當使用 EMEA- 照顧及需要額外治療 . </li></ul><ul><li>住宿 ( 居住 , 服務與照顧 / 治療 ) , 為有特殊方便性需求者 . </li></ul>
  31. 31. Accomodation <ul><li>Care level packages for intramural care: for the elderly (somatic and psychogeriatric [eg dementia]), physically disabled, sensory disabled (vision, hearing, communication), mentally disabled, young people with a light mental disability and people with psychiatric problems. </li></ul><ul><li>The packages are built up from living with little care and support up to packages with lot of care and support (24 hours, 7 days a week); including day care activities. </li></ul><ul><li>Financing of this kind of care is based on these packages. </li></ul><ul><li>In short: more care .. more money (for the care provider). </li></ul>
  32. 32. 住宿 ( Accommodation ) <ul><li>地區照顧層級配套組合 : 針對老人 ( 有身心需求者 [ 如失智症 ]), 肢體障礙 , 感官障礙 ( 視覺 , 聽覺 , 溝通 ), 心智障礙 , 輕度心智障礙青年以及精神障礙者 . </li></ul><ul><li>配套組合服務從需要少量的照顧與支持到需要大量的照顧與支持 (24 小時 , 一週 7 天 ); 包含日間照顧活動 . </li></ul><ul><li>這類照顧的經費是以這些套組為基礎 . </li></ul><ul><li>簡而言之 : 越多照顧 .. 越花錢 ( 為照顧提供者 ). </li></ul>
  33. 33. Examples care level package <ul><li>VV package 1: Sheltered living with little support </li></ul><ul><li>Client can do daily activities him/herself, but sometimes need reminding sometimes. </li></ul><ul><li>Client sometimes feels alone, has doubts about activities during the day. </li></ul><ul><li>Client receives 3 to 5 hours personal care/support per week. </li></ul><ul><li>VV package 5: Protected living with intensive dementia care </li></ul><ul><li>Client needs assistance with all daily activities (e.g. washing, clothing, eating). </li></ul><ul><li>Client needs support to keep grip on his/her life (e.g. not able to understand the time, lose the way). </li></ul><ul><li>Client receives 16,5 to 20 hours personal care/support per week. </li></ul>
  34. 34. 照顧配套層級範例 <ul><li>VV 套組層級 1: 少量支持的庇護性居住 </li></ul><ul><li>顧客可自行從事日常活動 , 但有時需要提醒某些事 . </li></ul><ul><li>顧客有時會覺得自己一個人 , 白天對有些活動不確定 . </li></ul><ul><li>顧客每週接受 3~5 小時的個人照顧 / 支持 . </li></ul><ul><li>VV 套組層級 5: 失智症密集照顧式的保護居住 </li></ul><ul><li>顧客在所有日常活動都需要支持 ( 例如 . 清洗 , 衣著 , 飲食 ). </li></ul><ul><li>顧客需要支持以掌握他 / 她的生活 ( 例如 , 無法理解時間 , 迷路走失 ). </li></ul><ul><li>顧客每週接受 16,5~20 小時的個人照顧 / 支持 . </li></ul>
  35. 35. Examples care level package <ul><li>LVG youth package 1: </li></ul><ul><li>Youngster lives as independently as possible (eg. in a grouphome), but needs support and some form of treatment. </li></ul><ul><li>Support is aimed to make youngster more independent; treatment to deal with e.g. behavioural problems. </li></ul><ul><li>Youngster receives 12,5 to 15,5 hours a week help. </li></ul><ul><li>LVG youth package 5: Living in a closed setting with intensive treatment and support </li></ul><ul><li>Youngster, with mild mental disability but with severe behavioural problemes, lives in a closed setting and is being watched all day. </li></ul><ul><li>Treatment centre arranges everything: living, school, freetime. </li></ul><ul><li>Youngster receives 27 up to 33 hours per week help with personal care, treatment by specialist, support social activities etc. </li></ul>
  36. 36. 照顧配套層級範例 <ul><li>LVG 青少年 套組層級 1: </li></ul><ul><li>青少年盡可能的可以獨立生活 ( 如 . 在團體家庭 ), 但需要支持與某些形式的治療 . </li></ul><ul><li>支持的目的是為了讓青少年更獨立 ; 治療處遇是在處理行為問題 . </li></ul><ul><li>青少年一週接受 12,5 ~ 15,5 小時的協助 . </li></ul><ul><li>LVG 青少年 套組層級 5: 住在密集治療與支持的封閉式環境 </li></ul><ul><li>輕度心智障礙者但伴隨極嚴重行為問題的青少年 , 住在封閉式環境 , 需要整天的監督 . </li></ul><ul><li>治療處遇中心安排所有事宜 : 居住生活 , 就學 , 閒暇時間 . </li></ul><ul><li>青少年每週接受 27~ 33 小時的協助 , 包含個人照顧 , 特殊專業人員的治療 , 社交活動支持等 . </li></ul>
  37. 37. You have a care indication, what next? <ul><li>You decide, which care provider you want to go to. </li></ul><ul><li>If there is place available, you can go and live there and / or receive the care you need. The care indication is specified in a careplan (agreement between client and care provider). </li></ul><ul><li>When the care provider of your choice has no available place, there are two options: </li></ul><ul><li>You put your name on a waiting list. In the meantime you can receive temporarily alternative care. </li></ul><ul><ul><li>You go to another care provider. </li></ul></ul>
  38. 38. 當你有了照顧指標 , 接下來呢 ? <ul><li>你決定選擇哪個照顧提供者 . </li></ul><ul><li>如果有名額 , 你可以申請並住在那裡 , 且 / 或接受你需要的照顧 . 在照顧計畫中會明列照顧指標 ( 顧客與照顧提供者簽訂協議 ). </li></ul><ul><li>當你選擇的照顧提供者沒有名額時 , 有兩個選擇 : </li></ul><ul><li>列入等待名單 . 同時你可以接受臨時的替代性照顧 . </li></ul><ul><ul><li>尋求另一個照顧提供者 </li></ul></ul>
  39. 39. Care functions for Personal care budget <ul><li>Personal care, such as help with everyday activities. </li></ul><ul><li>Nursing, such as help with the use of medicines. </li></ul><ul><li>Support assistance, support with activities indoors and outdoors, such as day care or learning to cope with your disability or problems. </li></ul><ul><li>Short stay away from home, such as weekend care. </li></ul>
  40. 40. 個人照顧預算的功能 <ul><li>個人照顧 , 如日常活動的協助 . </li></ul><ul><li>看護 , 如協助服藥 . </li></ul><ul><li>支持協助 , 支持室內 / 外的活動 , 如日間照顧或學習克服障礙或問題 . </li></ul><ul><li>短期離家 , 例如週末照顧 . </li></ul>
  41. 41. Assessment <ul><li>The first steps are the same as for care in kind: Regional Assessment Office determines how much care is needed and gives client a care indication. </li></ul><ul><li>Choose between care in kind and a personal care budget (PCB). Average PCB is 75% of the care in kind budget. </li></ul><ul><li>The Care Office grants a PCB and pays the PCB into clients bank account (minus own risk / contribution to costs). </li></ul><ul><li>Client purchases care; client is responsible for quality. </li></ul><ul><li>Client accounts for expenditure (Care Office checks accounts). </li></ul><ul><li>Client pays unspent money back to the care liaison office. </li></ul>
  42. 42. 評估 <ul><li>所有照顧類型的第一步驟皆相同 : 由地方評估部門決定需要的照顧額度 , 並給照顧指標 . </li></ul><ul><li>在實務照顧與個人照顧預算 (PCB) 間做選擇 . 平均而言 , 個人照顧預算佔實務照顧預算的 75%. </li></ul><ul><li>照顧部門同意個人照顧預算 ( PCB ), 然後支付存入到顧客的銀行帳戶 ( 扣除掉自擔風險 / 費用捐助 ). </li></ul><ul><li>顧客購買照顧 ; 顧客需要為品質負責任 . </li></ul><ul><li>顧客帳戶支出 ( 照顧部門會查帳 ). </li></ul><ul><li>尚未花用的餘款 , 顧客須繳回照顧聯絡部門 . </li></ul>
  43. 43. Personal care budget <ul><li>Client purchases on her/his own the care needed as well as the paperwork (accounts e.g.). </li></ul><ul><li>Client arranges on her/his own the care needed but contract out the paperwork e.g. to the Social Provisions Bank or commercial mediation offices. </li></ul><ul><li>Client contract out both the arrangement of care as well as the paperwork to commercial mediation offices. </li></ul>
  44. 44. 個人照顧預算 (Personal care budget) <ul><li>顧客購買自己所需的照顧與文書工作 ( 如帳戶 ). </li></ul><ul><li>顧客購買自己所需的照顧 , 但文書工作外包給例如社會服務 (Social Provisions Bank) 或是商業調解部門 (commercial mediation offices). </li></ul><ul><li>顧客將所需的照顧與文書工作都外包給商業調解部門 </li></ul>
  45. 45. Who chooses for PCB? <ul><li>Disabilities: </li></ul><ul><li>50% people with physical problems. </li></ul><ul><li>20% disabled people. </li></ul><ul><li>30% people using mental health services. </li></ul><ul><li>Age: </li></ul><ul><li>40 % < 18 ( growing) </li></ul><ul><li>40 % 18 – 65 </li></ul><ul><li>20 % >65 </li></ul><ul><li>Who are care givers: </li></ul><ul><li>1/3 by professionals. </li></ul><ul><li>1/3 by family / friends. </li></ul><ul><li>1/3 by professonals as well as family / friends. </li></ul>
  46. 46. 誰選擇使用個人照顧預算 ( PCB ) ? <ul><li>障礙者 : </li></ul><ul><li>50% 是肢體障礙者 . </li></ul><ul><li>20% 障礙人士 . </li></ul><ul><li>30% 使用心理健康服務人士 . </li></ul><ul><li>年齡 : </li></ul><ul><li>40 % < 18 ( 成長中 ) </li></ul><ul><li>40 % 18 – 65 </li></ul><ul><li>20 % >65 </li></ul><ul><li>誰是照顧者 : </li></ul><ul><li>1/3 由專業人員 . </li></ul><ul><li>1/3 由家人 / 朋友 . </li></ul><ul><li>1/3 由專業人員與家人 / 朋友一起 . </li></ul>
  47. 47. Fraud <ul><li>Reports have emerged concerning the fraudulent use of PCB. </li></ul><ul><li>From 1 July 2009 the PCB can only be paid into the account of the adult budget holder or their legal representative. </li></ul><ul><li>The budget holder has to account for the PCB himself. </li></ul><ul><li>Since February 2009 the National Care Assessment Centre (CIZ) published a guideline for assessors with instructions on how to act if pressure is exerted by intermediary agencies to award an assessment involving more care than is actually required. </li></ul><ul><li>Per Saldo, the Association of Personal Budget Users, and the Ombudsman Foundation, drew up a code of conduct in June 2009. This forms a starting point for developing a quality mark for intermediary agencies with a view to preventing clients from falling prey to fraudulent agencies. </li></ul>
  48. 48. 舞弊 <ul><li>開始有報告關注使用個人照顧預算引起的舞弊 . </li></ul><ul><li>從 2009 年 7 月 1 日起 , 個人照顧預算只能支付到成年的預算持有人帳戶或是他們法定代理人的帳戶 . </li></ul><ul><li>預算持有人須為自己的個人照顧預算記帳 . </li></ul><ul><li>從 2009 年 2 月起 , 國家照顧評估中心 (CIZ) 出版了評估者指引 , 提供指導如何面對中介單位高估實際照顧需求的壓力 . </li></ul><ul><li>在 2009 年 6 月 , Per Salvo, 個人照顧預算使用者協會 ( the Association of Personal Budget Users ) , 與 Ombudsman 基金會制定了行為守則 . 這個形式開啟了為中介單位發展品質檢核 , 避免顧客墮入舞弊的機構 . </li></ul>
  49. 49. Facts <ul><li>Average budget: € 16,500 per year </li></ul><ul><li>Maximum budget: € 300 per day / over € 100,000 per year </li></ul><ul><li>< € 50,000 per year: 96% </li></ul><ul><li>> € 50,000 per year: 4% </li></ul>
  50. 50. 事實 <ul><li>平均預算 : 每年 16,500 歐元 </li></ul><ul><li>最高預算 : 每天 300 歐元 / 每年超過 100,000 歐元 </li></ul><ul><li>< 每年 50,000 歐元 : 96% </li></ul><ul><li>> 每年 50,000 歐元 : 4% </li></ul>
  51. 51. Number of PCB users 1.845 109.000 2008 1.455 90.000 2007 1.136 95.000 2006 922 78.000 2005 726 70.000 2004 651 63.000 2003 413 48.000 2002 266 37.000 2001 151 23.000 2000 Budget (in € mln) Numbers PCB-holders Year
  52. 52. PCB 的使用人數 1.845 109.000 2008 1.455 90.000 2007 1.136 95.000 2006 922 78.000 2005 726 70.000 2004 651 63.000 2003 413 48.000 2002 266 37.000 2001 151 23.000 2000 預算 ( 以百萬歐元計 ) PCB 持有人數 年
  53. 53. Way of supply Target groups Care in kind Personal budgets Both Demented elderly people Elderly people with physical/somatic disorders Disabled people People with psychiatric disorders 70.000 295.000 85.000 50.000 1.000 19.000 19.000 32.000 1.000 5.000 9.000 2.000 Total 500.000 71.000 18.000
  54. 54. 輸送方法 目標族群 實務照顧 個人預算 兩者 失智老人 身心障礙老人 障礙者 精神障礙者 70.000 295.000 85.000 50.000 1.000 19.000 19.000 32.000 1.000 5.000 9.000 2.000 總計 500.000 71.000 18.000
  55. 55. Costs € 14,500 € 1.3 Personal budget € 58,500 € 22,000 € 14.8 € 5.9 <ul><li>Care in kind: </li></ul><ul><li>institution </li></ul><ul><li>home care </li></ul>Average amount per client (euro’s) Total costs (billion euro’s)
  56. 56. 費用 € 14,500 € 1.3 個人預算 € 58,500 € 22,000 € 14.8 € 5.9 <ul><li>實務照顧 : </li></ul><ul><li>機構 (institution) </li></ul><ul><li>居家照顧 (home care) </li></ul>每位客戶平均 ( 以歐元 ) 總費用 ( 以億歐元 )
  57. 57. Other organisations (long-term care field) <ul><li>ZN: is the sector organisation of the private health insurers as well as the Health care offices. </li></ul><ul><li>CAK: calculates and collect the own risk / contribution of clients; is responsible for the payment to EMEA care providers (via Health care office). </li></ul><ul><li>CVZ: advises about the package of the Health Insurance Act and the Exceptional Medical Expenses Act. </li></ul><ul><li>NZA: supervisor to the care (behaviour of care providers and insurers in relation to the law; determines the conditions of the free market health care. </li></ul>
  58. 58. 其他組織 ( 長期照顧領域 ) <ul><li>ZN: 是私立區域性的健康保險業組織 , 同時也是健康照顧服務部門 . </li></ul><ul><li>CAK: 計算並收集顧客的自擔風險 / 費用捐助 ; 需負責支付費用給 EMEA 的照顧提供者 ( 透過健康照顧部門 ). </li></ul><ul><li>CVZ: 針對健康保險法案與特別醫療支出法案 (EMEA) 的配套組合提供建議 . </li></ul><ul><li>NZA: 針對照顧服務提供督導 ( 照顧提供者的行為以及保險業者相關法律 ; 決定健康照顧自由市場的狀況 ). </li></ul>
  59. 59. Ageing (a global perspective) <ul><li>%65+ %growth </li></ul><ul><li>2005 2030 2005-2030 </li></ul><ul><li>Netherlands 14.1% 22.3% 58% </li></ul><ul><li>Taiwan 10.2% 24.3% 133% </li></ul><ul><li>China 7.6% 16.5% 117% </li></ul><ul><li>USA 12.6% 19.2% 52% </li></ul><ul><li>Japan 19.0% 31.9% 68% </li></ul><ul><li>S. Korea 8.7% 21.1% 142% </li></ul><ul><li>Australia 12.7% 20.8% 64% </li></ul><ul><li>World 7.4% 12.0% 62% </li></ul>Source: OECD/CPIRC/WHO/US Census
  60. 60. 老化 ( 全球觀點 ) <ul><li>65 歲以上 % 成長 % </li></ul><ul><li>2005 2030 2005-2030 </li></ul><ul><li>荷蘭 14.1% 22.3% 58% </li></ul><ul><li>台灣 10.2% 24.3% 133% </li></ul><ul><li>中國 7.6% 16.5% 117% </li></ul><ul><li>美國 12.6% 19.2% 52% </li></ul><ul><li>日本 19.0% 31.9% 68% </li></ul><ul><li>南韓 8.7% 21.1% 142% </li></ul><ul><li>澳洲 12.7% 20.8% 64% </li></ul><ul><li>全世界 7.4% 12.0% 62% </li></ul>資料來源 : OECD/CPIRC/WHO/US Census
  61. 61. Developments / challenges <ul><li>Sustainability of the long term care, also in relation to </li></ul><ul><li>growing population 65 years and older. </li></ul><ul><li>shortage labour capacity in the health care. </li></ul><ul><ul><li>More investments (regulation,finance) in care at home. </li></ul></ul><ul><li>Quality of care: transparancy and improvement. </li></ul><ul><li>Client more central in the care: more personal budgets, clients involved in care, agreements about care (care plan). </li></ul><ul><li>Better connection between HIA – EMEA - SSA. </li></ul>
  62. 62. 發展 / 挑戰 <ul><li>長期照顧的支撐能力 , </li></ul><ul><li>65 歲以上老人人口持續成長 . </li></ul><ul><li>照顧服務產業勞力能力的短缺 . </li></ul><ul><ul><li>對在家照顧更多的投資 ( 法規 , 經費 ). </li></ul></ul><ul><li>照顧品質 : 透明化與改善 . </li></ul><ul><li>更以顧客為照顧的中心 : 更個人化預算 , 顧客參與照顧服務 , 對照顧 ( 照顧計畫 ) 要簽訂協議 </li></ul><ul><li>在 HIA – EMEA - SSA 有更好的連結 . </li></ul>
  63. 63. Social Support Act <ul><li>The Social Support Act (SSA) is in force from 1 January 2007. </li></ul><ul><li>Municipalities are in charge for the implementation. The minister defines the framework in which each municipality can make its own policy, based on the composition and demands of its inhabitants. </li></ul><ul><li>Aim : participation of all citizens to all facets of the society, whether or not with the help from friends, family or acquaintances. </li></ul>
  64. 64. 社會支持法案 (Social Support Act) <ul><li>自 2007 年 1 月 1 日起強制施行社會支持法案 (SSA). </li></ul><ul><li>由地方負責執行 . 部會定義體制架構 , 各地方可依所組成的居民與需求制定自己的政策 . </li></ul><ul><li>目標 : 不論是否需要朋友 、家人或熟識者的協助 , 所有公民皆可參與社會的所有面向 ,. </li></ul>
  65. 65. Entrance to the Social Support Act <ul><li>Assessment either by the SSA-unit of the regional Assessment Office (since 2008 in operation) or by the municipality itself. </li></ul><ul><li>Collective or individual. </li></ul><ul><li>Care in kind or personal budget. </li></ul>
  66. 66. 進入社會支持法案 <ul><li>可由地方評估部門的社會支持法案 - 單位 ( 自 2008 年開始運作 ) 進行評估 , 或是由市府進行評估 . </li></ul><ul><li>集體或個人 . </li></ul><ul><li>實務照顧或個人預算 . </li></ul>
  67. 67. Municipality are in charge for <ul><li>Neighbourhood well being & civic society. </li></ul><ul><li>Provisions for disabled like wheelchairs, house-adaptations, adapted (public) transport. </li></ul><ul><li>Home care; domestic care. </li></ul><ul><li>Respite care. </li></ul><ul><li>Public health provisions. </li></ul>
  68. 68. 市府負責 <ul><li>鄰里福祉 & 公民社會 . </li></ul><ul><li>為障礙者提供服務如輪椅 , 住屋調整改善 , 調整改善 ( 大眾 ) 交通 . </li></ul><ul><li>居家照顧 ; 家務照顧 . </li></ul><ul><li>喘息照顧 . </li></ul><ul><li>公共健康服務的提供 </li></ul>
  69. 69. Nine performance fields (1) <ul><li>1 °. The promotion of social cohesion and quality of life in villages, districts and neighbourhoods. </li></ul><ul><li>2°. Prevention-focused support for growing up young people and parents experiencing problems raising their children. </li></ul><ul><li>3°. The provision of information, advice and client support. </li></ul><ul><li>4°. Supporting informal carers, including helping them to find effective solutions if they are temporarily unable to carry out their tasks, and supporting volunteers. </li></ul>
  70. 70. 九項表現領域 (1) <ul><li>1 °. 推動鄰里 、 鄉鎮等地區對生活品質的社會凝聚力 . </li></ul><ul><li>2°. 將預防焦點放在青少年父母扶養小孩所面臨的問題 . </li></ul><ul><li>3°. 提供資訊 , 建議與顧客支持 . </li></ul><ul><li>4°. 支持非正式照顧者 , 包含當他們暫時無法執行工作時 , 協助找到有效的解決方法 , 與志工支持 . </li></ul>
  71. 71. 5°. The promotion of participation in society and the independent functioning of people with a disability or chronic mental problem and of people with psychosocial problems. <ul><li>6°. The provision of services for people with a disability or chronic mental problem and people with psychosocial problems. </li></ul><ul><li>7°. The provision of social relief, including women’s refuge and the pursuit of policies to combat acts of domestic violence. </li></ul><ul><li>8°. The promotion of public mental health care, except for the provision of psychosocial aid in the event of disasters. </li></ul><ul><li>9°. The promotion of addiction policy. </li></ul>
  72. 72. 5°. 推動障礙者或慢性精神障者或有心理障礙者參與社會與獨立能力 . <ul><li>6°. 提供障礙者或慢性精神障礙者或心理障礙者所需的服務 . </li></ul><ul><li>7°. 提供社會救濟 , 包含婦女庇護與尋求對抗家暴政策 . </li></ul><ul><li>8°. 推動公共心理健康照顧 , 除災害發生時所提供的心理援助 . </li></ul><ul><li>9°. 推動成癮政策 . </li></ul>
  73. 73. How ‘non-committal’ is the municipality? <ul><li>Very free </li></ul><ul><li>Freedom of policy about allocation, awarding, granting. </li></ul><ul><li>No obligatory reportage to the national government. </li></ul><ul><li>Substitution within additional budget & within total regular budget. </li></ul><ul><li>Freedom of choice concerning indication / detection. </li></ul><ul><li>Not completely </li></ul><ul><li>Obligation to formulate a policy (a plan) to be adopted by the Council. </li></ul><ul><li>Relevant persons and parties have to be involved. </li></ul><ul><li>Personal budgets (as a form) must be awarded if desired. </li></ul><ul><li>Benchmark-suitable information must be published. </li></ul><ul><li>Compensation principle. </li></ul>
  74. 74. How ‘non-committal’ is the municipality? <ul><li>非常自由 </li></ul><ul><li>資源分配 、 獎勵與補助政策的 自由 . </li></ul><ul><li>不須對國家政府報告 . </li></ul><ul><li>在額外預算與例行總預算內替換 </li></ul><ul><li>對指標 / 檢測上可自由選擇 . </li></ul><ul><li>非完全 </li></ul><ul><li>需制定政策 ( 計畫 ) 經由理事會通過 . </li></ul><ul><li>相關人士與政黨需參與 . </li></ul><ul><li>如果有欲求就要提供個人預算 (as a form). </li></ul><ul><li>基準 - 適合的資訊要公開出版 . </li></ul><ul><li>補助原則 . </li></ul>
  75. 75. Compensation principle <ul><li>To compensate for the limitations experienced by a person in his ability to live independently and his participation in society, the Municipal Executive shall take measures which enable him: </li></ul><ul><li>to run a household; </li></ul><ul><li>to be mobile in and around the dwelling; </li></ul><ul><li>to use means of transport for local mobility; </li></ul><ul><li>to meet other people and, in so doing, form social relations. </li></ul>
  76. 76. 補助原則 <ul><li>為了補助因障礙而限制其獨立生活與參與社會的經驗 , 市府應提供措施來協助他 : </li></ul><ul><li>經營一個家 ; </li></ul><ul><li>能在住家內與四周移行 ; </li></ul><ul><li>可使用交通工具在地方上移行 ; </li></ul><ul><li>可與其他人碰面 , 如此一來 , 建構社交關係 . </li></ul>
  77. 77. Better home in the neighbourhood <ul><li>Programme by the Ministry of Health, Welfare and Sports and the Ministry of Housing. </li></ul><ul><li>Chain of housing – welfare – care facilities. </li></ul><ul><li>Promotes the diversity in housing and care. </li></ul><ul><li>Support programme focussed on the promotion of cooperation between local parties. </li></ul>
  78. 78. 在鄰里有更好的家 <ul><li>由健康福利與運動部門與居住部門共同提出的方案 . </li></ul><ul><li>住宅–福利–照顧設施的連鎖 . </li></ul><ul><li>推廣多樣化的住宅與照顧 . </li></ul><ul><li>支持方案是聚焦在鼓勵地方團體的合作 . </li></ul>
  79. 79. Government measures to housing <ul><li>Private initiaves for small scaled housing for the elderly with a need for care (physical or mental [e.g. dementia]). </li></ul><ul><li>Complete care package at (your own) home (‘VPT’; EMEA). </li></ul><ul><li>More possibilities for the division of living and care (EMEA). </li></ul><ul><li>More possibilities for small scale, private houses (private money with assistance of PCB from EMEA or SSA). </li></ul><ul><li>Parent initiatives for small scaled housing for people with disabilities (EMEA-PCB). </li></ul><ul><li>FOKUS-homes; independent living for people with (severe) physical disabilities with assistance on call (EMEA). </li></ul><ul><li>Adaptations in at home (SSA). </li></ul><ul><li>Law on equal treatment, part Housing. </li></ul>
  80. 80. 政府的住宅措施 <ul><li>私立單位倡議為有需要的老人提供小型住宅 ( 身體或心理 [ 如失智症 ]). </li></ul><ul><li>完成在家照顧的配套 ( 在自己的家 ) (‘VPT’; EMEA). </li></ul><ul><li>居住與照顧部門更多的責任 (EMEA). </li></ul><ul><li>小型私人住宅有更多的可能 ( 自付並由從 EMEA 或 SSA 的個人照顧預算提供支持協助 ). </li></ul><ul><li>父母倡議為障礙者提供小型住宅 (EMEA-PCB). </li></ul><ul><li>FOKUS-homes; 為極重度肢體障礙者提供隨傳隨到協助 (EMEA), 支持可獨立生活與居住 </li></ul><ul><li>居家調整改善 (SSA). </li></ul><ul><li>同等待遇 , 分開住宅 (part Housing) 的法律法案 . </li></ul>
  81. 81. Government measures to housing <ul><li>Residential care (EMEA) </li></ul><ul><li>Nursing homes: financial investments to adapt multiple occupancy rooms into one-person rooms (privacy). </li></ul><ul><li>Institutions for disabled: financial investments to adapt rooms so the rooms are in good state (e.g. sanitation, size). </li></ul><ul><li>Small scaled housing for people with dementia in the neighbourhood (EMEA). </li></ul>
  82. 82. 政府的住宅措施 <ul><li>住宅照顧 (EMEA) </li></ul><ul><li>護理之家 : 經濟投資 , 將多人房改為單人房 ( 隱私 ) </li></ul><ul><li>障礙服務機構 : 經濟投資 , 改善房間狀況 ( 如 : 衛生 , 大小 ). </li></ul><ul><li>為失智者在社區鄰里提供小型住宅 (EMEA). </li></ul>
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