Background information about dementia and home care services
In 1991, a Consultative Commission was set up to look into the possibility of creating a dependency insurance scheme. Users, carers and voluntary as well as private organisations were all invited to participate in the consultation which eventually led to the introduction of a dependency insurance in 1999. This was part of the government’s dual policy to support elderly and disabled people in their own homes for as long as possible whilst at the same time developing user-oriented care strategies.
Between 1998 and 2003, 17,933 requests for assistance were registered by the Ministry of Social Security. Of these, 83.2% were from people over 70 and of the accepted applications, 62.6% were from people in need of home care (Ferring and Weber, 2005).
Legislation relating to the provision of home care services
The Law of 19 June 1998 (“Assurance Dépendance”) led to the introduction of an obligatory dependency insurance on 1 January 1999 (sometimes referred to as long-term care insurance or “LTCI”). This covers expenses linked to the care of elderly residents in old people’s homes or assistance at home.
Organisation and financing of home care services
The dependency insurance is financed by people (whether they are Luxembourg residents or simply commuters from the surrounding countries) who contribute to the Luxembourg sickness insurance. For the monthly contribution, each person pays 1% of their total gross income (less a quarter of the minimum social salary). There are plans to increase this to 1.4% in the near future (Di Bartolomeo, 2006). For Luxembourg residents, investments, rental and other sources of income are also included in the calculation for annual contributions.
Before home care services are provided, a person must have a needs assessment which involves a medical examination and an evaluation of their level of dependency. This is organised by the “Cellule d’Evaluation et d’Orientation” (CEO) which is comprised of a multidisciplinary team under the authority of the Ministry of Social Security. According to the dependency insurance law, a person is considered as dependent if due to a disease or a physical or mental disability, he or she regularly needs a considerable amount of assistance from a third party in order to carry out basic daily tasks (i.e. at least 3.5 hours per week).
The final decision concerning entitlement to services and the amount of services to be provided is taken by the Union of Sickness Funds (“ Union des caisses de maladie ”) based on information about the assessment carried out by the CEO. The Union of Sickness Funds is responsible for:
- the individual classification of dependency, as well as the attribution, reduction and suppression of the different benefits and services;
- the payment of nursing services, the elaboration of nursing contracts and the negotiation of the monetary value of nursing services;
- negotiation with service providers concerning the provision of nursing aids (Ferring and Weber, 2005).
Dependent people receive a nursing allowance of € 23.85 per hour which can be used to finance informal care e.g. provided by a relative, friend or significant other. However, if the estimated amount of care to be provided is between 7 and 14 hours per week, at least half of the services must be provided by help networks e.g. “Hëllef Doheem”. If the person is in need of more than 14 hours of services per week, such services must be completely provided by the help networks (Ferring and Weber, 2005).
In addition to services provided by informal carers and the established help networks, there are about 23 associations, registered with the Ministry of Family Affairs, which operate on a voluntary basis.
Kinds of home care services available
The person appointed to provide care is responsible for assisting and supporting the dependent person in performing basic acts of living or partially or totally performing these acts for the dependant person. This could include:
- Help with tasks that are essential for daily living:
- Personal hygiene – washing, brushing teeth, skincare and going to the toilet
- Nutrition – preparing meals for special needs, assistance with eating and drinking
- Mobility – getting up, going to bed, changing position, getting dressed and undressed, standing up, going up and down stairs, going out and returning to one’s home.
- Help with domestic tasks:
- 2.5 hours per week of domestic assistance (extended to 4 hours in case of special needs e.g. with washing clothes in case of incontinence)
- Individual support e.g. stimulating and motivating the person to do activities
- Group support e.g. gym, manual work, going on walks
- The dependency insurance also covers special equipment (e.g. beds, wheelchairs etc.) and adaptation of a person’s home (e.g. special doors, chair lift etc.)
- Respite care:
- Every year, the person in need of care receives twice the amount of his/her nursing allowance which can be used to finance a stand-in person for three weeks’ respite care.
- Di Bartolomeo, M. (2006): information given in speech at the “Cross Atlantic Exchange to advance long-term care” conference held on 13 September 2006 in Bruxelles (organised by AARP and the European Commission)
- EFILWC (2002), Dependency insurance in Luxembourg , www.eurofound.ie/living/socpub_cstudies/lu1.htm
- Ferring, D. and Weber, G. (2005), National Background Report for Luxembourg , EUROFAMCARE. http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_luxembourg_rc1_a4.pdf
- Hartmann-Hirsch, C. et al. (1999), L’Assurance Dépendance; guide pratique , Ministère de la Sécurité Sociale
- Horsburgh & Co. S.A. (2005), Assurance Dépendance , www.horsburgh.lu/assurdepend.html
Last Updated: mercredi 15 juillet 2009