Background information about dementia and home care services
In 1987, legislation more or less put a stop to the construction of conventional nursing homes for older people and encouraged the development of independent specialised housing as well as home care services (Leeson, 2004). The current trend is to try to enable people to remain at home for as long as possible.
In Denmark, there is a classification system based on age with people over 60 forming the 3rd age group and those over 80 the 4th age group. There are approximately 700,000 people over the age of 67 in Denmark (the official retirement age). Of these, 172,000 receive long-term home-help and a further 7000 to 8000 people receive temporary home-help. The vast majority of people receiving long-term home-help live in their own homes. (Leeson, 2004). Jarden and Jarden (2002) estimate that there are about 189,000 people over 80 in Denmark. A high percentage of the 4th age group receive home care services.
Legislation relating to the provision of home care services
The Law on Social Assistance (1976) states that all communes must provide home help for the elderly. There is no difference between the social protection offered to people suffering from dementia and that offered to people who are dependent. The Social Service Legislation contains a few relevant references (taken from Leeson, 2004):
According to paragraph 67a of the Social Services Legislation, local or regional authorities must determine whether there are any relatives or other people who could represent the older person i.e. in an advocacy role.
Paragraph 71 part 60 states that local authorities should take into consideration the global situation of the older person, including the overall network, when assessing the need for assistance. Relatives are expected to participate in supporting the older person in the home. It is also suggested in part 96 of paragraph 71 that a relative should assist in completing the various application forms and that everyone should be made aware of this possibility.
Paragraph 72 deals with respite care. It states that local authorities are obliged to provide respite help to spouses, parents or other close relatives caring for a physically or mentally disabled person.
Organisation and financing of home care services
The Danish healthcare system provides free and equal access to health care to all residents. It is funded through general taxation but access to care is not dependent on a person’s financial status. Home care is divided into two categories - long-term or temporary. Long-term home care is provided free of charge but people may be asked to contribute towards the costs of temporary home care depending on the level of their income (Jarden and Jarden, 2002).
According to the Ministry of Social Affairs (2002), a goal has been established to improve the organisation of dementia care in order to ensure good coordination between local authority services and the provision of treatment and care by the health service. Furthermore, the development of partnerships between the public and voluntary sectors is emphasised, for example in areas such as respite care.
Since 1989, the Integrated Home Service has encouraged medical personnel to work in the home care sector and social workers to work in medical institutions which permits a more flexible approach to home care particularly in times of need. Since 1 July 1989, dependent elderly people have been entitled to permanent and free home help.
Such assistance is offered following an assessment of the functional capacity of the person, of his or her needs and on the basis of the service level determined by the local authority (Ministry of the Interior and Health/Ministry of Social Affairs and Gender Equality, 2002).
In accordance with the Preventive Home Visits to the Ageing Law of July 1996, local authorities are obliged to offer preventive home visits to all citizens over 75 years of age at least twice a year. The aim of these visits is to encourage older people to use their own resources better and consequently allow them to preserve their functional capacities as long as possible and also to be informed of the resources available from the municipality. The elderly person can freely decide whether or not to accept the home visit and can decide which subjects should be discussed.
Since 1 July 2002, people receiving personal or practical services have been entitled to exchange the services that they have been allocated for other services that they would prefer (Ministry of the Interior and Health/Ministry of Social Affairs and Gender Equality, 2002). Since 1 January 2003, older people have had the right to choose the providers of the personal and practical help and assistance to which they are entitled. Local authorities therefore have to ensure that there are several service providers from which to choose. The older person can then decide whether they would prefer the help with personal care and/or practical tasks to be provided by a private person, the local authority or an authorised service provider. This means that a family member could be chosen and would be paid by the local authority. This had been possible for a long time for practical help but it has now been extended to encompass personal care (Jarden and Jarden, 2002).
Kinds of home care services available
Local authorities must provide nursing care in service users’ homes and offer help and assistance to maintain physical and mental capacity. Such assistance should be provided in such a way that it encourages the participation of the older people and helps them to manage alone thereby maintaining their autonomy for as long as possible.
Home care services may include 24 hour assistance from a nurse, the provision of meals, the possibility to adapt the home, day care centres, financial assistance and transport facilities. Sometimes this may also include having an alarm system, maintaining the garden and clearing away snow. Certain services, such as minor repair jobs, are not provided by the local authorities. Some voluntary associations offer assistance with such jobs. Otherwise, the person can purchase the services from the private sector.
Meals may be delivered to the home by the local authorities at a subsidised rate. They are sometimes prepared in residential homes and then distributed within the community. Day care centres also have meals facilities.
Local authorities may also provide or finance services aimed at keeping people active or promoting their health. Sometimes, such services are proposed and/or organised by voluntary associations but financed by the local authorities. Such services might include sports activities, tuition/lectures and companionship for older people who are lonely. In 1998, the Social Service Law introduced a yearly budget for the development and expansion of voluntary services (Jarden and Jarden, 2002). DaneAge is an association, with a nationwide network, which offers older people a wide range of activities and opportunities to socialise. It also provides respite care for carers of people with dementia and trains volunteers so that they can provide such services in people’s homes. These volunteers are of all ages and from all walks of life (Leeson, 2004). Respite care is also offered by some nursing homes.
Consultation with people with dementia and carers
At the request of the Ministry of Social Affairs, 8 communes took part in a project based on home care for elderly people with dementia and their families. Some of the communes sent out questionnaires to obtain qualitative and quantitative information on the needs of the people with dementia and their carers.
The municipality of Vejle organised a project aimed at assessing users’ satisfaction with home care services, getting a picture of how resources were used, establishing a common notion of what quality and quality objectives are and drawing up a plan for the achievement of defined objectives. Users, employees and politicians were all involved in the project. Users were involved in drawing up the questionnaires. There were also group and individual interviews for which the elderly-talk-to-elderly method was used. It was felt that involvement of users and an elderly persons council was effective in motivating people. (This project was not limited to people with dementia.) (EFILWC, 2002)
- European Foundation for the Improvement of Living and Working Conditions (EFILWC) (2002), Denmark – http://www.eirpfpimd.ie/living /socpub_cstudies/de3.htm (accessed 31/5/2005)
- Jarden and Jarden (2002), Social and health-care policy for the elderly in Denmark, Global Action on Aging, http://www.globalaging.org/elderrights/world/densocialhealthcare.htm
- Leeson, G.W. (2004), National Background Report for Denmark, EUROFAMCARE, http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/ nabare_denmark_rc1_a4.pdf
- Ministry of the Interior and Health & Ministry of Social Affairs and Gender Equality (2002), Questionnaire on health and long-term care for the elderly, European Commission http://europa.eu.int/comm/employment_social/social_protection/health_en.htm
- Witsoe-Lund, L. and Ibenfeldt-Schultz, L., Le système d’aide et de soins aux personnes âgées atteintes de démence sénile de type Alzheimer au Danemark. In Joël, M.-E. et Cozette, E. (2002), Prise en charge de la maladie d’Alzheimer en Europe, Inserm
Last Updated: mercredi 15 juillet 2009