Legislation relating to home care services:
People in Norway are not legally obliged to provide care for their parents.
National legislation obliges the health and social services to provide home care services to those who need them. However, there is no specific reference to people with dementia.
Act no. 66 of 19 November 1982 on Municipal Health Services describes the duties of the health services as follows:
- The promotion of health and prevention of illness, injuries and physical defects
- Diagnosis and treatment of illness, injuries or physical defects.
- Medical rehabilitation.
- Nursing and care outside health institutions.
The municipalities have to provide the following services:
- General medical practices
- Nursing, including home care services.
§ 1-3a. The municipality shall plan, organise and provide the services regulated in the law. The people receiving care shall
- feel safe, respected and have a foreseeable situation
- be able to take care of themselves as long as possible
- have their basic physical needs taken care of
- receive adequate help with meals and have enough time to eat in peace
- receive help with personal hygiene and bodily functions
- receive help, if needed, to dress and undress
- be able to follow the natural rhythm of the day, avoiding unwanted stays in bed
- have the possibility for privacy and self-determination
- be able to have social contact
- be able to participate in suitable activities both indoors and out of doors
- have necessary medical check-ups, treatment, rehabilitation and care
- have necessary dental check-ups and treatment (Axel Wannag, 2000).
Act no. 81 of 13 December 1991 on Social Services, Chapter 1, Section 1-1, states that the purpose of the Act is:
- to promote financial and social security, to improve the living conditions of disadvantaged persons, to contribute to greater social equality and to prevent social problems.
- to ensure that each individual has the possibility to lead an independent, active and meaningful life together with others
Chapter 4, Section 4-1 describes the aims of social services as being to provide information, advice and guidance in order to resolve or prevent social problems. If the social services are unable to provide such assistance, they must, if possible, make sure that others do.
The Social Services consist of (section 4-2 in the Act):
- practical assistance and training to people who need it due to illness, disability, age or for other reasons
- short-term care in order to relieve carers with a particularly heavy burden
- support to individuals and families who need it due to disability, age or social problems
- institutional care for those who need it due to disability, age or other reasons
- financial aid to carers with a particularly heavy burden
People who are unable to care for themselves are entitled to help (Section 4-2, a-d).
The legal right to necessary health services is also underlined in the Patients' Rights Act of 1999 (Ingebretsen and Eriksen, 2004).
Organisation and funding of home care services
Home care services for the elderly and disabled are organised, managed and financed by the municipalities. Users may have to pay a fee for some of these services. The size of the fee varies from one municipality to the next.
Most of the municipalities (80%) offer services 24 hours a day. Approximately 155,000 people received home care services in 1999 (European Observatory on Health Care Systems, 2002).
"Report No. 20 to the Parliament (1996-97), Plan of Action for Care of the Elderly; Security - Respect - Quality" is a four-year plan of action for nursing and care services run by the local authorities. The main aim of this plan was to develop local services for nursing and care by:
- providing services that ensure the elderly a secure and, as far as possible, a fulfilling and independent life;
- enabling the elderly to live in their own homes as long as possible;
- making sure that the services have sufficient capacity
This was achieved through general guidelines including:
- ensuring high-quality nursing and home care services
- developing an integrated, flexible range of services
- providing equal facilities nationwide, independent of a person’s place of residence, income or resources
- ensuring greater participation and freedom of choice to service users
According to Ingebretsen and Eriksen (2004), the goals of this action plan, which include the strengthening of home-based care, have to a large extent been achieved, albeit with considerable regional variations. This has led to more home-based care. It should be noted, however, that Norway is a very sparsely populated country with great variation between municipalities in terms of socioeconomic structure, population etc.
The provision of services is based on a person’s needs regardless of whether they live alone or with a spouse/family. In this way, the assessment is based on the condition of the person requiring assistance and not on the ability or willingness of relatives to provide services or meet needs. In practice, however, elderly people living alone are sometimes given priority. (Ingebretsen and Eriksen, 2004).
In June 1998, the Norwegian parliament adopted the National Programme for Mental Health. Implementation of this programme started in 1999 and will run until 2008. A document entitled “Mental Health Services in Norway – prevention, treatment, care” produced by the Norwegian Ministry of Health and Care Services can be found at: http://odin.dep.no/filarkiv/233840/MentalHealthWeb.pdf
Kinds of home care services available
Home care services typically include:
- Leisure activities
- Assistance handling personal finances
- Ensuring that medication is taken
- Personal hygiene
- Getting dressed and undressed
- Technical aids
Day care centres exist but are not statutory.
Consultation with people with dementia and carers
Although no specific reference is made to people with dementia in the National Programme for Mental Health, reference is made to the ICD classification F00-F009 (organic, including symptomatic, mental disorders). The report emphasises the importance of the patients’ perspective (referred to in the report as the “user”):
“Fundamental for the reform of mental health care in Norway is the emphasis placed on the users’ views and perspectives on services. The experience and knowledge possessed by users and their relatives, is unique and necessary in improving and optimising services and treatment. Participation is also vital for empowerment and for the ability to master one’s own life. This is of great value and a central vision of the National Programme for Mental Health.
Users and close relatives should be involved at all levels in the decision-making process. At the system level this implies organised participation by users and relatives in planning processes, legislation, implementation of treatment programmes etc. It is of major importance that users’ perspectives are taken into consideration in decision-making throughout the services (political, administrative and professional) and at all levels (Ministry, municipalities, hospitals etc.). Accordingly, national as well as local authorities should be co-operating with users’ organisations and unions in these matters. At the individual level, the policy implies a legal right to participate in the management of necessary services.” (Norwegian Ministry of Health and Care Services, 2005, p.6)
It is further stated that patients’ needs must guide the provision of services and that cooperation with patients and their families is required at all levels.
- Anonymous, Security – respect – quality, Action plan for care of the elderly 1998 – 2001, Health Care Systems in Transition, HiT Summary, Norway, European Observatory on Health Care Systems, http://www.observatory.dk
- Information provided by Inger Jorun Edvardsen and Maija Juva
- Ingebretsen, R. & Eriksen, J. (2004), National Background Report for Norway, EUROFAMCARE, http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_norway_rc1_a4.pdf
- Ministry of Health and Social Affairs website ( http://odin.dep.no/hod/engelsk/publ/handlingsplaner/030005-990070/dok-bn.html )
- Norwegian Ministry of Health and Care Services (2005), Mental Health Services in Norway, prevention – treatment – care, Helse- og Omsorgsdepartementet ( http://odin.dep.no/filarkiv/233840/MentalHealthWeb.pdf )
- Wannag, A. (2000), Caring for the carers; a review of issues (notes from conference), http://www.phcttb.org/projects/Qualityofcare.htm - accessed on 29/4/2005
Last Updated: mercredi 15 juillet 2009