Background information about dementia and home care services
According to the “Icelandic National Health Plan to the year 2010” published by the Ministry of Health and Social Security in 2004, “With the appropriate services and support it is fair to assume that more people would be able to stay longer at home. (…) It is important to emphasise the need to maintain and enhance physical and mental abilities, in order for senior citizens to be able to stay as long as possible in their own homes.”
Methods to achieve this are outlined. These include:
- the need to strengthen and increase cooperation and coordination of home help and
- the need to increase the availability of day care and health centre home services, in which the emphasis should be on round-the-clock, 7-day service and short-term hospitalisation.
The Ministry has set itself a target, namely that by 2010 “more than 70% of citizens over the age of 80 will retain their health to the extent that they can with the appropriate support services, continue to live in their homes and participate in daily life.”
Legislation relating to the provision of home care services
In Iceland, there are a few laws which specifically deal with issues related to the elderly. The first was enacted in 1982 and was then revised in 1989 and 1999. The underlying principle of these laws is that the elderly should be respected. The laws also state that the elderly have a legal entitlement to the services that they need and that consequently the state must ensure that their needs are met in a way that is relevant and economically feasible (Jónsson and Pálsson, 2005).
The purpose of the Act on the Affairs of the Elderly, No.125 of 31 December 1999 (Act no.125 of 1999) is stated as being “to ensure that the elderly are able, for as long as possible, to enjoy a normal domestic life and that they are assured the required institutional services when needed.” An elderly person is defined as being a person aged 67 or older.
This legislation, combined with the high cost of nursing home care and the desire of many elderly people to continue living in their own homes, has resulted in an increased demand for home care services (Johnson and Olafsdottir, 2005).
Home care in Iceland includes health care and social services. The former is in the hands of health care centre employees pursuant to the Act on Health Care Services. The latter is handled by municipalities or the parties with which the municipalities have contracted, pursuant to the Act on Municipal Social Services.
Organisation of home care services
In each health care centre district there is a service council for the elderly. This service is responsible for ensuring that the elderly receive the services they need, that they are informed of the options available to them and that their needs for institutional care are assessed (Act no.125 of 1999, article 8).
Home nursing services are usually provided by community health centres. Such care is organised on a regional basis. Other kinds of home care services (sometimes referred to as homemaker services) are organised by the social services sector, also on a regional basis.
Financing of home care services
The national health insurance finances home nursing care almost entirely. It is paid for by the state through the central government’s budget. Social services for the elderly (including home care and days care) are paid for by county councils which are funded by local governments. Nursing in the home is therefore free. Payment for other home care services is related to income. Therefore, clients may have to pay a small contribution towards the costs of such services. There are no cash benefits for home care.
People attending day care centres must pay up to a maximum amount of one full basis pension (i.e. EUR 217 per month) (MISSOC, 2005).
People who are in need of care can obtain a reimbursement for care costs along with their pension provided that they are on a very low pension. If eligible, the amount is calculated on the basis of each individual case in terms of percentages (35%, 70%, 90% or 120%) and paid to the person with dementia. In July 2001, this amounted to EUR 75, EUR 149, EUR 192 and EUR 256 respectively.
Spouses my be entitled to special compensation amounting to 80% of the flat rate state pension for providing care at home if they:
- have suffered a loss of income as a result of stopping full-time employment;
- have incurred extra expenses linked to day care or paid home help;
- are on a low income e.g. if the spouse has no income.
Kinds of home care services available
Chapter IV, article 13 of the Act no.125 of 1999 provides the following examples of geriatric services (which would also be available to elderly people with dementia).
- Home care services provided to the elderly residing at home. The service shall be based on case-by-case assessments of service needs and shall be geared to support for self-help. Home care services shall be provided in the evening, at night and on week-ends if necessary. An effort shall be made to organise and co-ordinate the health care and social aspects of the home care services with the welfare and needs of the elderly person in mind.
- Service centres for the elderly which are operated by municipalities to ensure that senior citizens are provided with company, nourishment, exercise, recreation, entertainment and health surveillance. Service centres may work independently or in connection with other services enjoyed by the elderly.
- Day-care centres for the elderly as a supporting measure for those who require supervision and care on a regular basis in order to continue to live at home. Day-care centres for the elderly shall provide nursing services and be fitted with facilities for exercise and medical services. Transportation services shall be provided to and from the home of the individual, as well as health assessments, exercise, recreation, social support, education, counselling and assistance in the activities of daily life.
- Serviced apartments for the elderly which may be privately owned, rented or residential rights apartments. Prior to the construction of serviced apartments for the elderly, construction permits must be obtained from the Minister for Health and Social Services pursuant to Article 16. Serviced apartments for the elderly shall be fitted with security systems and a choice of varied services, such as catering, laundry and cleaning and access to social activities. Payment for services provided shall be governed by the provisions of Article 20. The residents of serviced apartments shall be entitled to the same home and watch services as other residents of the municipality.
Consultation with people with dementia and carers
The “Icelandic National Health Plan to the year 2010” mentions the objective of ensuring that every health care institution establishes a formal quality development procedure and follows its own plan with regard to quality issues and that over 90% of patients should be satisfied with the health care services they receive. It is not clear to what extent this would apply to the provision of home care services for people with dementia.
- Act on the Affairs of the Elderly, No.125, 31 December 1999 (with amendments up to Act No.38/2004), http://eng.heilbrigdisraduneyti.is/media/Laws%20in%20english/Act_on_the_Affairs_of_the_Elderly.pdf#search='Act%20on%20the%20Affairs%20of%20the%20Elderly%20AND%20Iceland '
- Alzheimer Europe (2001), Equality in the Provision of Care at Home, Alzheimer Europe
- Health information Unit of WHO Regional office for Europe, Highlights on Health in Iceland, http://www.who.dk/document/E72496.pdf
- Johnson, P. and Oafsdottir, T. (2005), WHHO-Compendium Text (extract on Iceland), http://www.nahc.org/WHHO/WHHOcomptext.html
- Jónsson, P. V. and Pálsson, H. (2005), Toward informed and evidence-based elderly care: the RAI experience in Iceland, http://www.milbank.org/reports/interRAI/Iceland.html
- MISSOC (2005), Comparative tables: Iceland, http://www.europa.eu.int/comm/employment_social/missoc/2002/is_part12_en.htm
- The Ministry of Health and Social Security (2004), The Icelandic National Health Plan to the year 1020, abridged version, http://www.heilbrigdisraduneyti.is/media/Skyrslur/heilbenska5mai.pdf#search='Icelandic%20National%20Health%20Plan '
Last Updated: mercredi 15 juillet 2009