Background information about dementia and home care services
In 1993, the Federal State and the individual provinces made an agreement to further develop common measures by 2010 with regard to the provision of services for those in need of care. This was to include home nursing, elderly care and home help. An interim report dated 31.12.2002 revealed, however, that the provision of mobile services was unevenly distributed. Nevertheless, by December 2002, an additional 1,727 full-time care worker posts had been created (compared to the period 1995 to 1997) within Austria, excluding Vienna. In 2003, there were plans to create a further 2,191 full-time posts by 2010 (Blaha, 2006).
The main providers of home care services are the Red Cross, Caritas, social welfare organisations, relief organisations and “Volkshilfe”.
Legislation relating to the provision of home care services
There are two main pieces of legislation of relevance to the provision of home care services. These are the Federal Long-Term Care Allowance Act and the Provincial Long-Term Care Act. Agreements between the federal and provincial authorities were signed in May 1993 and were implemented in January 1994. Consequently, long-term care allowances are uniform throughout Austria. The federal act covers people who are entitled to social security pensions (i.e. 90% of the population) whereas the provincial act covers those who are not i.e. the remaining 10% of the population (Brodsky et al. 2000).
The law governing the assessment of the need for care is the Ordinance on Care Allowance levels (Einstufungsverordnung zum BPGG). The actual financing of care is the responsibility of the 9 provinces, each of which has its own law.
According to Austrian civil law, married couples are legally responsible for each other’s maintenance. They can fulfill this obligation by means of payment or the provision of services. Under certain circumstances, children may be held legally responsible for the maintenance of their parents. In Vorarlberg, even grandchildren may be held responsible for the maintenance of their grandparents. According to social assistance laws in most provinces, children may, in certain circumstances, be obliged to contribute towards the costs of community care and residential care for their parents. Numerous decisions have been made by the Supreme Federal Court with regard to the conditions upon which the provisional authorities can demand that relatives contribute towards the cost of care.
Organisation and financing of home care services
Coordination centres exist but vary from one province to the next. They deal with medical and non-medical home nursing as well as care services linked to the social insurance.
Eligibility for the long-term care allowance is based solely on the level of disability and the amount of assistance needed. It is not means tested and is financed through general tax revenues not through social insurance contributions. Nevertheless, it should be noted that employee and employer contributions were increased just before the Long-Term Care Allowance Acts came into force (Brodsky et al., 2000).
There are seven levels of disability. Level 1 is the lowest level and intended for people whose disability necessitates between 50 and 74 hours of care per month, whereas levels 4 to 7, are for people who require 180 hours of care or more. Another condition for eligibility is that the person has a permanent need for personal care for at least 6 months. Private physicians are responsible for deciding on eligibility and the level of disability.
People who have been judged eligible for the care allowance are paid a cash benefit on a monthly basis. This is exempt from tax and can be spent in any way that the recipient sees fit e.g. to pay for services or to pay an informal carer. This is intended to enable people to stay at home for as long as possible and to promote self determination and family support. Recipients who are cognitively impaired may have a legal representative appointed to manage the care allowance on their behalf (Brodsky et al., 2000). The vast majority of formal services are provided by NGOs.
With the exception of the long-term care allowance, the financing of care needs is determined by a person’s income, assets and recourse to their children’s income. Despite efforts over the last ten years to harmonise legislation, this is still governed by provincial legislation (Blaha, 2006).
Although there are no official figures, it is believed that an illegal work market is steadily growing for paid carers from the Czech Republic, Slovakia, Hungary and Poland. They are usually paid between EUR 1,200 and EUR 1,800 for 24 hour in-house care (Hörl, 2005). Discussions are currently being held at the highest level in order to decide whether to legalise this situation. This would result in additional costs for those employing such workers, as they would be obliged to also pay social insurance contributions (Blaha, 2006).
Kinds of home care services available
The kinds of services available include home help, personal care, meals-on-wheels, companionship and laundry. There are also community care centres, sometimes known as pensioners’ clubs, which offer cultural and leisure activities, as well as light meals. Day care centres exist. Some are for all elderly people and some are for specific groups such as people with multiple sclerosis or dementia. It is also possible to apply for subsidies for home adaptations which would facilitate home care.
Carers who find themselves temporarily unable to provide care, due to illness, holidays or other reasons, can ask for a replacement carer. This is only possible for carers of people who are classed as being at disability level 4 or above on the long-term care allowance scale.
Consultation with people with dementia and carers
In the framework of the “Qualitätsversicherung in der häuslichen Betreuung” of 2002, people receiving the long-term care allowance, along with their informal carers, were asked during a home visit about their level of satisfaction with the initial contact, the provision of information and referral to services etc. (Blaha, 2006).
- Blaha, M. (2006), Information provided by fax on 11 August 2006
- Brodsky, J., Habib, J. and Mizrahi, I. (2000), A review of long-term care laws in five developed countries,
- http://www.wu-wien.ac.at/wwwu/institute/Sozialpolitik/LTC.pdf#search ='A%20review%20of%20longterm%20care%20laws%20in%20five%20developed%20countries'
- Hörl, J. (2005), National Background Report for Austria , EUROFAMCARE,
- http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/ nabare_austria_rc1_a4.pdf
- Kodner, D. L. (2003), Consumer-directed services: lessons and implications for integrated systems of care. International Journal of Integrated Care, 17 June 2003 http://www.ijic.org/publish/issues/2003-2/index.html?000137
Last Updated: mercredi 15 juillet 2009