Italy has an aging population that is increasing the demand for long-term care services. The national healthcare system provides some long-term care funded through taxation, but households also bear significant costs. Care is provided both formally through community care, residential care and cash benefits, and informally often by immigrant workers providing home care. There are regional differences in Italy, with northern areas having more developed long-term care systems while family typically provides more care in southern areas. The government is attempting reforms to standardize and improve long-term care nationally through increased funding and coordination across levels of government.
Carl Evans from the Department of Health and a member of TLAP's steering group on Information and Advice discussed new Care Act duties related to the provision of information & advice and the shift in emphasis to 'proportionality'.
PowerPoint Presentation giving a brief history of care and support and the context for the current changes to the social care system. Presentations was delivered by Simon Medcalf and Kevin Kitching at the 'Personalisation and the Care Act consultation events' hosted by TLAP, Department of Health, the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) on Monday 21st July 2014 in London and 23 July 2014 in Manchester.
Simon Medcalf is Deputy Director of Social Care Policy and Legislation at Department of Health and Kevin Kitching is Personalisation Policy Manager Social Care, Local Government and Care Partnerships Directorate at Department of Health.
Context, gender and sustainability in introducing and scaling-up essential he...ReBUILD for Resilience
Presented by Egbert Sondorp of KIT Royal Tropical Institute, Netherlands.
Part of a session - 'Context, gender and sustainability in introducing and scaling-up essential health care packages in fragile and crisis-affected countries' - at the Fifth Global Symposium for Health Systems Research in October 2018. The essential package of health services is a mechanism for expanding equitable coverage of primary health care and essential hospital services in countries recovering from conflict. The session explored the evidence-base on such healthcare packages in different contexts and prioritized areas for strengthening research.
Topic The Care Act: Implications for Homeless Health Care
Presenter Karl Mason
Social Work Lead - Trauma, Emergency and Acute Medicine Kings Lead KHP Homeless Pathway Team Kings
Ageing: Fiscal implications and policy responses -- Christian Lorenz, GermanyOECD Governance
This presentation was made by Christian Lorenz, Germany, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Carl Evans from the Department of Health and a member of TLAP's steering group on Information and Advice discussed new Care Act duties related to the provision of information & advice and the shift in emphasis to 'proportionality'.
PowerPoint Presentation giving a brief history of care and support and the context for the current changes to the social care system. Presentations was delivered by Simon Medcalf and Kevin Kitching at the 'Personalisation and the Care Act consultation events' hosted by TLAP, Department of Health, the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) on Monday 21st July 2014 in London and 23 July 2014 in Manchester.
Simon Medcalf is Deputy Director of Social Care Policy and Legislation at Department of Health and Kevin Kitching is Personalisation Policy Manager Social Care, Local Government and Care Partnerships Directorate at Department of Health.
Context, gender and sustainability in introducing and scaling-up essential he...ReBUILD for Resilience
Presented by Egbert Sondorp of KIT Royal Tropical Institute, Netherlands.
Part of a session - 'Context, gender and sustainability in introducing and scaling-up essential health care packages in fragile and crisis-affected countries' - at the Fifth Global Symposium for Health Systems Research in October 2018. The essential package of health services is a mechanism for expanding equitable coverage of primary health care and essential hospital services in countries recovering from conflict. The session explored the evidence-base on such healthcare packages in different contexts and prioritized areas for strengthening research.
Topic The Care Act: Implications for Homeless Health Care
Presenter Karl Mason
Social Work Lead - Trauma, Emergency and Acute Medicine Kings Lead KHP Homeless Pathway Team Kings
Ageing: Fiscal implications and policy responses -- Christian Lorenz, GermanyOECD Governance
This presentation was made by Christian Lorenz, Germany, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Evaluation of the strong involvement of the health sector in the Irish homele...FEANTSA
Presentation given by Frank Mills, Director Social Inclusion, South West Area Health Authority, Ireland at a FEANTSA seminar on "Cooperation & networking to address homelessness: What are key partners for national/regional authorities and how should they be involved?", co-hosted by the Norwegian Housing Bank and FEANTSA, June 2007
Dr Simon Duffy of the Centre for Welfare Reform describes the reality of welfare reform and describes the harm it is doing to already disadvantaged groups. He proposes that there is a better version of welfare reform that has not yet been explored.
Elderly care conference 2017 - The state of social care: the commissioning la...Browne Jacobson LLP
Joy looks at 'what is social care in the 21st Century and why it is important?' including the current state of the social care market and taking a look at the future.
Workshop E Marta Szebehely Work Care Reconciliation in the Nordic CountriesCare Connect
Presentations by Prof Marta Szebehely, Professor of Social Work, Stockholm University, Sweden and
Dr Outi Jolanki, Postdoctoral Research Fellow, University of Jyväskylä, Finland
Carers and Work-Care Reconciliation International Conference
University of Leeds, 13th August 2013
Progress on Self-Directed Support in Difficult TimesCitizen Network
These slides were produced by Dr Simon Duffy for the Changing Our Lives team who wanted to find out how to develop self-directed support as part of their work to advance human rights for people with learning difficulties. The slides include an overview on progress and obstacles in England during the era of austerity.
On 1 December 2015, the final M-CARE conference was organised in Brussels, Belgium at VLEVA premises. The event “Caring for people with disabilities and older people: challenges, opportunities and (mobile/online) training solutions” focussed on the importance of good quality personal caregiving (PCG) for people with disabilities and older people. Focus was on caring in a broader perspective, and how M-CARE’s (mobile/online) training solutions can contribute to successful PCGs.
More information at:
http://mcare-project.eu/
http://twitter.com/MCareproject
http://www.facebook.com/MCareproj
This project (M-Care - 539913-LLP-1-2013-1-TR-LEONARDO-LMP) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
The key role of the voluntary sector: the Dutch modelFEANTSA
Presentation given by Jaap van den Berg, Ministry of Health, Welfare and Sports, the Netherlands at a FEANTSA seminar on "Cooperation & networking to address homelessness: What are key partners for national/regional authorities and how should they be involved?", co-hosted by the Norwegian Housing Bank and FEANTSA, June 2007.
Evaluation of the strong involvement of the health sector in the Irish homele...FEANTSA
Presentation given by Frank Mills, Director Social Inclusion, South West Area Health Authority, Ireland at a FEANTSA seminar on "Cooperation & networking to address homelessness: What are key partners for national/regional authorities and how should they be involved?", co-hosted by the Norwegian Housing Bank and FEANTSA, June 2007
Dr Simon Duffy of the Centre for Welfare Reform describes the reality of welfare reform and describes the harm it is doing to already disadvantaged groups. He proposes that there is a better version of welfare reform that has not yet been explored.
Elderly care conference 2017 - The state of social care: the commissioning la...Browne Jacobson LLP
Joy looks at 'what is social care in the 21st Century and why it is important?' including the current state of the social care market and taking a look at the future.
Workshop E Marta Szebehely Work Care Reconciliation in the Nordic CountriesCare Connect
Presentations by Prof Marta Szebehely, Professor of Social Work, Stockholm University, Sweden and
Dr Outi Jolanki, Postdoctoral Research Fellow, University of Jyväskylä, Finland
Carers and Work-Care Reconciliation International Conference
University of Leeds, 13th August 2013
Progress on Self-Directed Support in Difficult TimesCitizen Network
These slides were produced by Dr Simon Duffy for the Changing Our Lives team who wanted to find out how to develop self-directed support as part of their work to advance human rights for people with learning difficulties. The slides include an overview on progress and obstacles in England during the era of austerity.
On 1 December 2015, the final M-CARE conference was organised in Brussels, Belgium at VLEVA premises. The event “Caring for people with disabilities and older people: challenges, opportunities and (mobile/online) training solutions” focussed on the importance of good quality personal caregiving (PCG) for people with disabilities and older people. Focus was on caring in a broader perspective, and how M-CARE’s (mobile/online) training solutions can contribute to successful PCGs.
More information at:
http://mcare-project.eu/
http://twitter.com/MCareproject
http://www.facebook.com/MCareproj
This project (M-Care - 539913-LLP-1-2013-1-TR-LEONARDO-LMP) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
The key role of the voluntary sector: the Dutch modelFEANTSA
Presentation given by Jaap van den Berg, Ministry of Health, Welfare and Sports, the Netherlands at a FEANTSA seminar on "Cooperation & networking to address homelessness: What are key partners for national/regional authorities and how should they be involved?", co-hosted by the Norwegian Housing Bank and FEANTSA, June 2007.
Talk given to local authority Chief executives on the way in which local government could re-imagine its own role - with a real commitment to supporting citizenship.
Dan Venables_LTC Consensus Meeting 10-Nov-2015angewatkins
PRIME Centre Wales
Long Term Conditions Consensus Meeting
Tuesday 10th November 2015, St Mary's Priory, Abergavenny, NP7 5ND
http://www.primecentre.wales/ltc-consensus-meeting.php
Dr Simon Duffy of the Centre for Welfare Reform explains how the bankruptcy of Northamptonshire County Council has been triggered by austerity, but was built on hyper-centralisation, privatisation and the failure of the commissioning model. He argues that its people need to head upstream to develop better social solutions and it needs more devolution of power and genuine democratic reform.
7. LTC system
• Definition ????
• National & local taxation are main funding sources of
public LTC.
• Homecare funded mostly by households
• Informal immigrant carers
• Ukraine immigrants
• “Without them, the national health system would edge
towards collapse.”
• Supply and Cost Vary
• Health Services
• Social Care Services
9. Differences and the
enduring debate
Northern Italy
• Care is widespread
• High female participation in
labor market
• More developed
management capabilities
and larger economic
resources
• Want a national, integrated
LTC system
Southern Italy
• Care burden rests on
family
10. Problems with LTC
• Severity of need is assessed differently by regions
• Municipalities are managed at the local level
• Each region has own classification system.
• However try to use international standards for the Geriatric
Evaluations
• No legal definition of persons that need care.
• Instrumental abilities have a secondary role
• Not taken into consideration or they are evaluated but not used
to calculate the level of need.
• Besides ADL, the Cumulative Illness rating Scale or
International Classification of Disease is used.
11. Management
• Italian National Health Service plans and manages
through Local health Units
• Home health services called integrated domicilary
care
• Municipalities -Personal social services domestic
and personal care tasks and institutional social care
are managed at the local level.
12. Governmental Differences
Central Government
• Has the power to set
system wide rules
• Responsible for monitoring
provision services
• Does it actually happen?
Regional
Government
• Responsible for quality
control on private
accredited providers
• Responsible for the
organization and
administration of publicly
funded healthcare
• Budgetary Balance Plans
13. Italian government
• The Italian National Health Service
• 1978
• Aims at providing uniform and comprehensive care
• Financed by general taxation
• Constantly undergoing reform
• 1989 : First Parliament Act was schedule
• Created 140,000 beds for non-self reliance people
• The Objective Project
• National Health Plan
• 2003 – 2005
• 2006 – 2008
14. Current Changes
• Rapid growth of demand for LTC systems
• Rapid Aging
• Family Structure
• More females in the Labor force
• New Ring-Fenced Fund
• Attempting to allocate resources at a national level instead
of a regional level
• LTC National Funds first available in 2010
• Agreement for the New Health Pact of 2010-2012
From 2000 – 2010, Italy had the “Mouse in the Python”
Narrow grouping in younger demographics, with a larger mass of older people aging
It’s projected that over time Italy’s demographics will balance out more
People are living longer and the fertility rate is decreasing
Life expectancy at birth is 80 years for males and 85 for female
Probability of dying under the age of 5 (per 1,000 live births) is 4%
Probability of dying of dying between the age of 15 and 60 (per 1,000 population) is 73% for males and 40% for females
Why do we think such a big gap?
In the United States, our homecare is funded differently ; Medicare
Ukraine immigrants make about $750 to $900 a month!
Saving the Italian economy
HEALTH SERVICES include outpatient and home services, semi-residential and residential services, psychiatric services.
Home health services called integrated domicilary care
SOCIAL CARE SERVICES are provided at the local level which include group interventions that are provided in nursing homes or semi-residential institutions
COMMUNITY CARE
RESIDENTIAL CARE
CASH BENEFITS provided and funded to all disabled persons independently from their age and economic conditions. Not linked to purchasing LTC services but is considered part of the system.
Provided by the National Institute of Social Security (INPS)
Similar to Medicare Waiver
Northern Italy :
Advocate for the creation of a national system
Southern Italy :
Southern Italy is poor and they receive little public support
BOTH : Current main obstacle is funding because of Italy’s high public debt
Debates have been going on since the early 90s in regards to reforming the LTC system
Municipalities -Personal social services, domestic and personal care tasks, and institutional social care
In comparison to the US – we use the DSM IV to classify diseases
REGIONAL GOVERNMENT :
Regions have responsibility for the organization and administration of publicly financed healthcare, regardless of central governments bonds and parameters, such as max bed/resident, celling for pharmaceutical expenditure.
Regions with High Debt must undergo Budgetary Balance Plans that must be implemented by the central government
Socialist run government
The Italian National Health Service (SSN) is Italy’s version of national health care
Similar to our Obamacare
Manages, plans and organizes health care through local units
The Objective Project “healthcare for elder people” approved in the National Health Plan 1992-1994 gave role to Evaluation Units for needs of assessment
National Health Plan
In November 2000 the National Law attempted to establish a minimum level of social care services to provide throughout the country.
National Health Plan (2003-2005) “cash and care” approach implying transferring money to families for purchasing health and social services qualified providers, aimed at supporting home care.
National Health Plan 2006-2008 identified strengthening home care as a first priority as opposed to instutional care.
New Ring-Fenced Fund approved in 2007- 100 million euros to implent the essential levels of care to non self sufficent persons over the country as a whole