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Integrated social and health services for older people: an italian example (Emilia-Romagna)

Raffaele Fabrizio, Bishkek, April 10th 2015

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Integrated social and health services for older people: an italian example (Emilia-Romagna)

  1. 1. “Integrated social and health services for older people: an italian example (Emilia- Romagna) ” Raffaele Fabrizio Bishkek, April 10th 2015
  2. 2. CENTRAL Goverment -Pension National care allowance -National Health system Standard professional skills - National FUND - compulsory standard of care REGION Organisation regional health care Social services planning (rules, standard, funding): authorization accreditation network (public and private) coaching Local Authorithies -Needs assestment -planning service with public fund support -use of resource ules for copayment -- contracting with providers monitoring quality
  3. 3. •About 450€ per month - criteria: 100% disabled people, need to be helped for ADL (activities day life) •No income’s limits •No control about how the money is used •No link with services' network • PEOPLE RECEVEING NCA: Italy: about 1,2 mln people =>65years old (about 6 milliards Euros per year) Emilia-Romagna 103.000 people: 10% of =>65years ; 20% of =>75years , about 600 millions € per year NATIONAL FUND? THE NATIONAL CARE ALLOWANCE (NCA)
  4. 4. Changes in the context: changes in the life Pension system Recent changes in the pension system Current average age at retirement 59,5 Prospective average age at retirement 67 Number pensioners in ER (2012) % pensioners % pensionars on less than euro 1.000/month National average monthly pension 1.331.283 30 40 832 euro
  5. 5. Local authorithies categories per number of inhabitans (to 01.01.2014) Number People % Up to 1,000 21 15.016 0,3 From 1,001 to 5,000 135 399.926 9,0 From 5,001 to 30,000 171 1.877.547 42,1 From 30,001 to 100,000 12 575.429 12,9 > 100,000 9 1.591.328 35,7 EMILIA-ROMAGNA REGION Inhabitants: 4.459.246 1.1.2014 9 PROVINCES 348 MUNICIPALITIES
  6. 6. EMILIA-ROMAGNA: context data
  7. 7. ECONOMICS GDP per capita 2013 E-R 32.500E-R 32.500 Italy 26.400Italy 26.400 EU 28 27.000EU 28 27.000 From ISTATFrom ISTAT Unemployment rate 15-64 2013 TotalTotal E-R 8,5%E-R 8,5% Italy 12,2%Italy 12,2% EU28 10,8%EU28 10,8% Older persons employment rate, persons aged 55 to 64 years, Lisbon strategy Goal 50% Italy 30 ER 40
  8. 8. Elderly : not only costs. elderly helps helderly volunteers and not only elderly (grandfather and grandmother «canguro») 646,520 at regional level (55,4% male – 44,6% female) 14,5% of total population Age of volunteers total % % in class 18-64 years 512.756 79,3% 19,3 =>65 years 133.764 20,7% 13,6 services for elerderly also an economic opportunity
  9. 9. MOBILITY Great help to elderly people is provided by social transport (to health services, cultural and social events, etc.) run by volunteer organisation (mainly by retired people) Social transport by volunteers (2010) Hours 1.171.803 Number transports 550.071 km 11.697.416
  10. 10. EMILIA-ROMAGNA REGION: DEMOGRAFIC TRENDS 1981 2001 2005 2013 2020 =>65 16,4 22,2 22,7 22,8 22,2 =>75 5,8 10,7 11,3 11,9 11,7 =>80 2,8 5,9 6,6 7,3 7,5 1981 1991 2001 2008 2013 2020 0-14 671.248 447.907 470.293 547.512 560.379 595.193 60-64 201.308 259.049 266.191 254.930 269.357 275.325 65-69 226.727 252.898 239.830 252.548 248.534 246.352 70-74 187.209 167.540 224.557 227.191 239.643 241.443 75-79 120.567 167.056 196.819 196.640 205.450 194.509 > 80 108.844 178.021 236.259 291.829 324.426 346.567 Total 3.922.388 3.909.512 4.037.095 4.275.843 4.471.104 4.635.400
  11. 11.   E-R Italia UE 25 % 0-14 anni 12,3 14,1 16,2 % 65 anni e più 22,8 19,5 16,7 % 75 anni e più 11,9 9 7,6 % 80 anni e più 7,3 5 4,1 Aging Index 167,9 147,2 112 EMILIA-ROMAGNA REGION: AGING INDEX E-R
  12. 12. Resident population Total males Foreign males Total females Foreign females - 53% of foreign population between 20 & 45 years old - Under 18 are increasing (23%) GENDER NATIONALITY AGE Age structure of the population residing in the ER by gender, citizenship and single year of age, 01/01/2013
  13. 13. •REGION: (Health services and FRNA) •ELDERLY: (people and families, including us of NCA) •LOCAL AUTHORITIES WHO PAYS THE COST OF SERVICES? NATIONAL FOUNDS? 40% 40% 20%
  14. 14. AN integrated system: Not only social and health The mainly problem: integrate all local policies(urbanistic planning, housing, transport, long life learning, tourism, social and health) FOCUS NOT IMPROVING ADMINISTRATION BUT ON THE SINGLE INDIVIDUAL.
  15. 15. FRAIL ELDERLY Multifactor approach health problems, functional deficit, social context, incomes loneliness no close relations No possible a general model without context analysis
  16. 16. 0 4 8 12 16 20 24 28 32 36 40 44 Meno di 25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 e oltre % M in unip %F in unip % MF in unip % total population 11,5% % =>75 34% % =>85 38% % Femm =>85 46% FAMILIES COMPOSED BY ONLY 1 PERSON (BY AGE GROUPS)
  17. 17. Services network forServices network for Not-selfsufficientNot-selfsufficient elderly peopleelderly people
  18. 18. SENIORS HEALTH: 3 LEVELS OF INTEGRATION INSTITUTIONAL AGREEMENT BETWEEN MUNICIPALITY AND AUSL ORGANIZATIONAL- OPERATING SENIOR ASSISTANCE SERVICE (SAA) Case manager Local Geriatrical evaluation Unit (UVGT) PROFESSIONAL
  19. 19. GERIATRICAL EVALUATION UNIT (UVG) •GERIATRICIST •NURSES •SOCIAL WORKERS •MULTI-DIMENSIONAL EVALUATION •INDIVIDUAL PLAN (PAI) •PROPOSAL USING SERVICES •FOLLOW UP GP OTHER SPECIALISTS Integrated Home care Nursing homes =CRA Caregivers and family assistant supporting Day centers= CD
  20. 20. Total no. of services Users per service % of services per =>75 population Providers Publi c Privat e non- profit Private for- profit TOTAL Residential (nursing homes) 328 17.556 3,1% 89 186 53 328 Day Care Center 215 3.342 0,6% 92 108 15 215 Regional Care Allowance 20.500 people 4 different levels in relation to the level of care provided by relatives: 280, 450, 700, 1050 euro per month Home care services 129 24.207 30 99 0 129 Day social activity center 354 Center 135.000 Members Volunteer Association SERVICES FOR THE ELDERLY in Emilia Romagna Region National Care Allowance 105.000 (=>65 years) 490 euro per month In ER 600.000.000 euro per year
  21. 21. Women from foreignWomen from foreign countries (mainly Easterncountries (mainly Eastern European) take on the taskEuropean) take on the task of caring for elderly andof caring for elderly and disabled people, sharing thedisabled people, sharing the same home.same home. How ointegrate familyHow ointegrate family assistant in the network?assistant in the network? How to reduce black marketHow to reduce black market for home care?for home care? Family assistants
  22. 22. • Integration of all actorsIntegration of all actors Some lessons we learnt • Access system:Access system:  Single door systemSingle door system  Multidimensional evaluationMultidimensional evaluation  Case managmentCase managment • Support caregivers and familySupport caregivers and family assistantassistant  TraningTraning  Respite care servicesRespite care services  Care allowanceCare allowance  Support self help groupSupport self help group
  23. 23. Some lessons we learnt • Planning specific approach forPlanning specific approach for emergencies:emergencies:  Hospital dischargeHospital discharge  Suddenly changes health or in theSuddenly changes health or in the supporting familysupporting family  Climate emergency (heartquacke)Climate emergency (heartquacke) • Provide servicesProvide services • Integrated data systemIntegrated data system • Innovation in soft, flexible and communityInnovation in soft, flexible and community services and opportunitiesservices and opportunities
  24. 24. Some lessons we learnt • Professional integration:Professional integration:  Good training for specific skillGood training for specific skill  Training and upgradeTraining and upgrade  Common approach and language for allCommon approach and language for all professionalsprofessionals  Common training on good relation withCommon training on good relation with elderly people and thei relativeselderly people and thei relatives
  25. 25. THANK YOU FOR YOUR ATTENTION rfabrizio@regione.emilia-romagna.it

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Raffaele Fabrizio, Bishkek, April 10th 2015

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