Background information about dementia and home care services
Home help services in Hungary were organised as early as the late 1960's, primarily to care for the elderly, patients with chronic conditions and the homebound.
In the past, many citizens in Hungary considered health and social services as a right of citizenship. Consequently, this led to lengthy hospital stays and less need for home care services from the family. According to Sovenyi et al. (2005), in 1993 one in five Hungarians spent an average of 12.4 days in the hospital.
The health care system has moved from centralised Semashko state control to a more pluralistic, decentralised model. It is mainly funded through social insurance contributions . The government has agreed to introduce a 1% nursing care insurance based on the German long-term care insurance system (Széman, 2004).
Legislation relating to the provision of home care services
In the past, adult children had financial obligations towards their parents according to Hungarian law. However, under the Local Government Act of 1990 and Act III of 1994 on Social Services, municipalities acquired responsibility for the elderly and disabled people, as well as for social care. The Act on Social Welfare of 1993 made it possible, in certain cases, for family carers to receive a fee for providing care (Széman, 2004).
Organisation and financing of home care services
Since 1993, each municipality has been required to meet local needs for home care, with contributions from the central budget based on the municipality's population size and number of inactive and unemployed persons. According to Széman (2004), this budget only covers about 80% of costs. The services are provided by professional caregivers and volunteers, as well as specialist nurses who provide home nursing services under a doctor's orders. Efforts are being made to establish a separate home care and nursing service and to expand the insurance-based system of delivery to the non-profit agencies. (Sovenyi, 2005).
Social care is funded through the welfare sector and not the health sector. The State relies heavily on cooperation with foundations, associations and church organisations. The practice of paying “gratitude money” persists in Hungary. Many elderly people feel that it is necessary in order to receive proper treatment. Some doctors even demand advance payments of “gratitude money”.
Under Hungarian law, an elderly person can sign a maintenance contract with a person of their choice whereby the appointed carer inherits the old person’s flat or house in exchange for caring for the elderly person. In the past, this led to cases of abuse but modern contracts with more safeguards now exist. Some people sign maintenance contracts with trusted neighbours (Széman, 2004).
Kinds of home care services available
Social care includes home care nursing for medical problems and home care social support e.g. the provision of medication and meals, house cleaning and assistance in maintaining personal hygiene. Help with laundry and shopping is also included but much of this is also carried out by voluntary associations.
Transport to the doctor is also the responsibility of local authorities but this service does not extend to transport to other places such as to church, social gatherings or even to the hospital for medical examinations. Fortunately, some NGOs provide such services.
Home nursing care is provided if prescribed by a doctor. In practice, many trained home help workers also provide home nursing care. The vast majority of home help workers are in fact trained nurses but the strict division between health and social care forbids this so both the elderly and the care workers sometimes falsify the records. The Maltese charity organisation provides integrated home care covering both home help and home care.
Clubs for the elderly exist where people who are still partly able to care for themselves can go during the day. In these clubs, elderly people can profit from 1 to 3 meals per day, have a bath and take part in activities (Széman, 2004).
Consultation with people with dementia and carers
The opinions of people with dementia and their carers, with regard to the quality of the services they receive, are not routinely sought by professional home care providers.
- Sovenyi, K., Szegedi, G. and Druskoczi, T. (2005), http://www.whho.org/WHHOcomptext.html#anchor569287
- Széman, Z. (2004), National Background Report for Hungary, EUROFAMCARE, http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_hungary_rc1_a4.pdf
Last Updated: mercredi 15 juillet 2009