Background information about dementia and home care services
In 1991, the Ministry of Health established and financially supported 40 non-governmental Home Care Agencies. The Czech Catholic Charity, the Czech Red Cross and several individual nurses set up the first private Home Care Agencies. Originally, these were intended mainly for the elderly, the chronically sick and the dying. 1993 saw the creation of the Association of Home Care whose role it was to collect data related to home care and to unite home care personnel.
In 2000, almost 107,000 people received home care services from home care agencies and about 80% of these were elderly people (aged 65 or over) in need of both health and social care (US Dept of Commerce, 2000). In 1995, there were 593 registered home care associations. Of these, 498 provided 24 hour round the clock comprehensive home care, 42 provided comprehensive home care on a limited basis and 53 provided specialised home care services for people with specific diagnoses e.g. neurological diseases, cancer etc.
Legislation relating to the provision of home care services
Decree No 182/91 of the Ministry of Labour and Social Care regulates the direct financing from local council budgets of individual social care and assistance. However, legislation on social services, dating from laws passed during the socialist era, persists, some of which has become unclear due to numerous changes that have since been made. The State is not actually obliged to provide social care.
The Volunteer Services Act No. 198 of 24 April 2002 lays down certain conditions for the involvement of volunteer workers in a number of domains including that of providing assistance to the elderly. It also contains provisions for the financial support of organisations which select, register and train volunteers e.g. in the form of pension payments, insurance payments and certain expenses.
Chapter 31 of the Charter of Fundamental Rights and Freedoms, which is contained in article 3 of the Constitution of the Czech Republic, states that “Everybody has the right to protection of his or her health. Citizens are entitled under public insurance to free medical care and to medical aids under conditions set by law.” This right does not, however, extend to social care. According to Holmerová (2004), the division between health care and social care is the main obstacle to the provision of care to the dependent elderly. Fortunately, some NGOs (such as the Diakonie, Charita and Czech Red Cross) and some municipalities provide both health and social care, thereby bridging this gap.
Dependency is defined in several laws but in a different way for each purpose and situation. In Act 100 on Social Security, which covers entitlement to an allowance, one of the criteria for dependency is that the person is over 80. Definitions governing entitlement to technical aids, household adaptations, and exceptional benefits and allowances exclude people with dementia.
With regard to carers in paid employment, the Act on Sickness Insurance (1956) entitles family carers to special leave to care for a sick relative. They receive an allowance of 69% of the average wage for the first 9 days of the sickness. This can only be claimed once for each specific diagnosis. The worker must also reside in the same household as the person who is in need of their care.
Organisation and financing of home care services
The health insurance system is currently based on a third party fee-for-service payment model and is compulsory. Health care is reimbursed by the general health care insurance but co-payments are necessary in some cases. Home health nursing services (up to 3 daily visits by a nurse to the patient's home) are reimbursed if provided by health professionals under contract to the insurance company and if approved by a physician. If more visits are required, patients must pay for them themselves.
Some social services, especially the care in homes for people with disabilities, on the other hand, are financed by the Ministry of Labour and Social Affairs. Some are provided and funded by regional authorities (residential homes) and by municipalities (home help). Clients may have to contribute towards such services depending on their income. Unfortunately, despite the recent increase in the number of providers, there may be a lack of provision of services to people with limited incomes due to a lack of adequate financing.
According to the National Plan on Ageing, one of the aims of the State is to develop a system of integrated home service, as a necessary condition to enable older people to remain home, which should be included in a new concept of health and social care. Nevertheless, in some municipalities, home help is simply not available. When questioned about the lack of home care services, municipalities frequently respond that the family should provide the necessary care or that institutionalisation is recommended (Veselá, 2003 in Holmerová).
Some home care associations recruit lay people, particularly students or elderly people, to assist them in their work. They also cooperate with NGOs, particularly those of elderly people such as Life 90. Some home care associations also provide information, education and practical training in simple as well as more specialised nursing techniques to relatives or people who are close to the patients in order to improve the health, wellbeing and/or quality of life of patients.
There are also social services agencies (about 400 in 2000) which offer some basic personal care (basic nursing care). Unfortunately, as there is no clear separation between health care and social care, problems with financing sometimes occur.
Kinds of home care services available
Home health care services may include both skilled and basic nursing care, as well as rehabilitative services, transportation, and counselling. Personal care in the home is usually considered as part of home nursing care. Personal assistance with everyday tasks is not covered by social care legislation and is not routinely provided.
Home help services include housework, shopping, laundry and meals-on-wheels. Some communities also offer a meal service for older people in the dining rooms of schools.
Transportation to and from health services is covered by general health insurance and is therefore free. Some day care centres also provide transport services. There are not many day care centres and many of those that exist are only open for a few hours a day. However, in the last few years, some day care units for people with dementia have been set up. They are usually open for more than 8 hours a day.
Information, counselling and respite care exist in the Czech Republic but are not covered by social care legislation. It is therefore left to the discretion of local authorities, NGOs and other organisations. Respite care in the form of short stays in respite centres, for example, is provided by the organisation Life 90. Respite care at home (“granny sitting”) is provided by the Czech Alzheimer Society.
- Act No. 198 of 24 April 2002 on Volunteer Services, amending certain regulations (Volunteer Services Act)
- Holmerová, I. (2004), National Background Report for the Czech Republic, EUROFAMCARE, http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/ nabare_czech_rc1_a4.pdf
- Misconiová, B. (2005), Comprehensive Home Care in the Czech Republic, unpublished report
- Topinkova, E. (2005), WHHO-Compendium Text (extract on the Czech Republic), http://www.nahc.org/WHHO/WHHOcomptext.html
- US Dept of Commerce (2000), Czech Republic: Home Care Medical Equipment, http://www.factbook.net/countryreports/cz/Cz_HomecareMedical_mkt.htm
Last Updated: mercredi 15 juillet 2009