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Poland

Social support systems

Organisation and financing of social support to people with dementia and carers

Background information on the social/healthcare system in Poland

During the period of independence (between 1918 and 1939), a limited Bismarckian social health insurance system was introduced, covering about 7% of the population. In 1945, a Ministry of Health was created and the State took over responsibility for health care.

In the 1980s, there was a series of health reforms aimed at decentralisation. Integrated healthcare management units, known as ZOZ (Zespól Opieki Zdrowotnej) that had been created in the 1970s were given greater power.

However, the general health insurance act of 1997 (enforced on 1 January 1999) brought back an insurance-budgetary model of health care funding whereby the State budget was no longer responsible for funding health services. Unfortunately, there were considerable regional differences in service provision and even different prices for the same service. These and other problems with the system led to the Law on General Insurance in the National Health Fund (enforced on 1 April 2003) which established the National Health Fund. The branches of the National Health Fund are responsible for providing health services to insured people. In 2004, the National Health Fund was officially declared not in accordance with the Constitution.

There is currently very little State provision of community care services. NGOs play an important role but services are still scarce. According to Kuszewski et al. (2005), there has been a parliamentary debate about a possible role for mutual insurances for health and social care, which would include separate long-term care insurance for the elderly. Source: Ministry of Health (2007) and WHO (2005).

The organisation of social support for people with dementia and carers

There is no system of social support specifically designed for people with dementia and their carers. However, people who are ailing or need social support, because they live alone or are dependent, are entitled to receive paid (or partly paid) home help and support organised by local governments.

There are special services for the elderly but none specifically for people with dementia. The Ministry of Labour and Social Policy is responsible for social support to people with dementia/dependent elderly people. The Ministry of Health is responsible for medical services only.

NGOs are involved in various activities aimed at providing services for people with dementia and their carers. The Ministry of Health may (or may not) co-finance certain activities and tasks of NGOs, but it is up to NGOs to fight for a better quality of life for people with dementia in Poland. The private sector provides some services, e.g. nursing homes, but they are not specially designed for people with dementia.

Support from the State (mainly the Ministry of Health) is inadequate and sporadic. The amount of money that organisations apply for from the government to finance their activities, which could help people with dementia and their families cope with the disease, is much greater than what they actually receive and the amount is decreasing every year, while the number of NGOs seeking financial support is increasing. For example, to cover the costs of the awareness activities and campaigns of the Polish Alzheimer Association, it has to look for other sponsors, as the government refuses to fund such activities. Since 2004, financial support from the Ministry of Health has been provided every year but very late in the year, so the resources that are eventually granted cover a period of just 4 or 6 months. Self-help organisations also apply to local government for financial support and, as in the above situation, the money only covers 8 to 9 months. In both cases, organisations must compete for financial support.

The overall funding of social support for people with dementia and carers

Social support for people with dementia and carers is funded through general taxation and an obligatory health insurance. In addition, people are asked to contribute towards the cost of any services they receive.

The legal framework surrounding the provision of social support

Certain articles of the Polish Constitution of 2 April 1997, covering economic, social and cultural freedoms and rights, could be of relevance to the provision of social support to people with dementia. For example:

Article 67

  • A citizen shall have the right to social security whenever incapacitated for work by reason of sickness or invalidity as well as having attained retirement age. The scope and forms of social security shall be specified by statute.

Article 68

  • Everyone shall have the right to have his/her health protected.
  • Equal access to health care services, financed from public funds, shall be ensured by public authorities to citizens, irrespective of their material situation. The conditions for, and scope of, the provision of services shall be established by statute.
  • Public authorities shall ensure special health care to children, pregnant women, handicapped people and persons of advanced age.

( http://www.sejm.gov.pl/prawo/konst/angielski/kon1.htm )

Other relevant legislation includes:

  • The Social Welfare Act of 12 March 2004 (Ustawa nr 64 z dnia 12 marca 2004 o pomocy spo?ecznej)
  • The Psychiatric Act (Ustawa o ochronie zdrowia psychicznego z 1994 r. - Dziennik Ustaw nr 111, poz 535 wraz z pó?niejszymi zmianami)

The Polish Alzheimer Society is not aware of any reforms underway which might eventually affect the level of support provided to people with dementia and their carers. It does not feel that people with dementia and their carers are the focus of the current government or MPs.

The suitability of social support for people with dementia and carers

Adequacy and accessibility in general

Social support for people with dementia and carers is neither adequate nor accessible. In fact, it is not generally available at all. The situation is very difficult especially in rural areas. Larger towns, where Alzheimer associations have been set up and are active, help people with dementia and their carers make use of the existing services available to the general public. The problem is that although general care services should be available to everybody in need, they are actually only accessible to low-income families.

Unfortunately, the available services do not meet the needs of people with dementia. Home helpers responsible for providing care at home are rarely qualified or properly trained to understand the needs of people with dementia. Family carers who are members of the Polish Alzheimer Association are often responsible for training the professional carers themselves.

People living in rural areas

As stated above, the provision of social support is especially difficult in rural areas. Services such as assistance with personal hygiene, day care centres and counselling for people with dementia are particularly difficult to find.

People with different types of dementia

As there are no services specifically designed for people with dementia in general, there are none for specific types of dementia either.

People from ethnic minorities

There are no specific services for people with dementia and carers from ethnic minorities.

Younger people with dementia

Age does not seem to be important as if a person has been diagnosed with Alzheimer’s disease, he/she has the same rights to use available services, especially if he/she has been granted the status of dependent person. However, there are no services specifically designed for younger people with dementia.

Services and support for people with dementia and their carers

Types of care

Day care

Day care is partly funded by the Sate and partly by service users.

However, very few cities have day-care centres. Some are run by NGOs, others by local governments. The latter are quite rare. In Warsaw, for example, there is only one such facility yet it is estimated that at least 11,000 people in Warsaw have dementia, with only 15% having been diagnosed. The Polish Alzheimer Association considers the provision of day care totally insufficient.

A few Alzheimer associations (e.g. in Lodz, Poznan, Lublin, Torun and Olsztyn) have managed to set up day-care centres but there is always a threat that the local government will suddenly withdraw financial backing for such services.

The Church also provides day-care services e.g. in Plock, but the quality of the service is questionable and without logistic support from NGOs there is a risk, according to the Polish Alzheimer Association, of doing more harm than good to people with dementia who are usually treated like children.

Respite care

Sitting services are generally available during the day but professional carers are not sufficiently trained and the service is only available for families on a low income. Moreover, it is not specifically designed for people with dementia. There is no night time respite service in Poland.

The State may contribute towards the cost of this service and service users may also have to pay a fee for this service. This is based on the income of the whole family in a particular household.

Short-term residential respite care exists but is insufficient. Existing long-term residential homes seldom want to admit people with dementia, simply because they are afraid of not being able to cope with various problems. It is not profitable for them to allow people to stay for short periods. Generally, such institutions do not want patients to stay for less than a month. The State contributes towards the cost of short-term and long-term respite care and service users must also pay a fee.

Long-term residential care

Although there are very few long-term residential homes solely for people with dementia, there are numerous homes for the elderly and frail. On average, 30% of the people admitted to such homes have dementia. Many have no prior diagnosis. Long-term residential care is partly funded by the state and partly by service users when the person using the service, or members of his/her family, cannot cover the full cost i.e. when their income is too low. The cost of long-term care varies. A few years ago long-term care homes charged 70% of a person’s pension, however much the pension was, but nowadays, each home calculates the costs and expects the users to cover them. The local government is only responsible for covering the remaining costs in the case of very poor people.

Palliative care

Palliative care is only available for people with cancer.

Monitoring in the home via alarm systems

Monitoring in the home via alarm systems is insufficient. It is provided solely by private agencies and is not specifically designed to be used by people with dementia.

Personal assistance and home help

Personal assistance

Assistance with personal hygiene is available, especially in big towns, but insufficient. Rural areas are usually neglected. As with other services, it is not designed specifically for people with dementia. Another problem is that only people on a low income are entitled to this service. If provided, it is partly financed by the State and partly by the service user.

Assistance with mobility e.g. lifting, moving and walking and social companionship/activities form part of the social support services that are generally available but they are not specifically designed for the needs of people with dementia. Therefore, they are insufficient. These services are partly financed by the State and partly by service users.

Social community nurses from outpatient clinics in a patient’s place of residence may, if available, visit the patient and instruct the family carer on how to deal with pressure sores. The family carer may then ask the nurse again if he/she can’t cope. This is totally insufficient. Service users with a high income/pension have to pay the full cost of the service. The state partly or in some cases almost fully pays for the service for people on a low income/pension. Alzheimer associations also provide training to carers on how to deal with such problems and where to find help. The Polish Alzheimer Association arranges for nurses to visit people with dementia at home.

Some NGOs provide nursing services to people with dementia in their own homes, but this is scarce. Moreover, it is costly to NGOs and financial support from the State is difficult to obtain for this service.

Disabled people who adapt their homes are entitled to refunds from the government. This only covers part of the cost.

The following services are not available:

  1. Supervision/assistance taking medication
  2. Assistance eating and drinking
  3. Assistance dealing with incontinence
  4. Occupation therapy/ergotherapy (unless available through day care centre)
  5. Assistive devices/assisted technology

However, people with dementia are entitled to 60 incontinence pads at half price provided that they obtain a prescription for them from a general practitioner.

Home help

A few home help services are available and partly funded by the State. They include:

  1. Assistance with housework
  2. Help with the preparation of meals (incl. meals-on-wheels)
  3. Assistance with shopping

However, as these services are not specifically designed for people with dementia and only available to people on a low income, they are insufficient.

There is no laundry service and no special means of transport for people with dementia. Carers who order a normal taxi may be entitled to some discount if they can prove that the patient is disabled.

Psychosocial support and training for people with dementia and carers

There is no general service to provide information about access to services in general. The Polish Alzheimer Association has a telephone helpline.

Counselling services for people with dementia and for carers are solely provided by Alzheimer Associations. For this reason, counselling services only exist in towns where there is an Alzheimer Association and there is a lack of such services in small towns and rural areas. This is insufficient. The Alzheimer Associations do not receive any funds from the State for counselling people with dementia. Counselling for carers is partly funded by the State.

Holiday services, specially designed for people with dementia, are only available if and when an Alzheimer Association can run them. The Polish Alzheimer Association has been running such forms of respite for more than 10 years, but it is getting more and more difficult, especially when no financial support is provided by the State. The State may contribute towards the cost but many carers are still unable to afford such holidays (two weeks may cost as much as their monthly salary/pension). There are no provisions for carers to have a holiday e.g. by providing a respite carer so that the carer can have a break.

The Polish Alzheimer Association and local Alzheimer’s organisations are the sole providers of training for family carers and this is considered insufficient. The State does not, as a rule, contribute towards the cost of this training, unless the Alzheimer associations are lucky enough to receive some funds from the Ministry of Health or from the local government for educational projects.

Work/tax related support for people with dementia

There are no protective measures for people with dementia in paid employment. They are not entitled to tax refunds for employing people to provide home care services and they are not entitled to direct payments to pay for services. However, a person with dementia, like any other disabled or elderly person (i.e. over 75 years of age), is entitled to a care benefit of 150 zloty (EUR 35) per month.

People with dementia, like disabled people, are entitled to tax refunds/benefits due to their incapacity and also for home adaptations. This is based on tax legislation.

People with dementia who have been granted the status of disability of the first category (i.e. they are unable to live independently) are entitled to certain reductions e.g. on television and radio licences. Public transport (buses, trams, the underground and some trains) can be used free of charge by people with dementia and their carers. This is covered by tax law, the Acts Monitor, nr.14 of 2004, article 176 (ORDYNACJA PODATKOWA, DZIENNIK USTAW nr 14 z 2004, pozycja 176).

Work/tax related support for carers and carer allowances

According to the Labour Code (KODEKS PRACY), every spouse or child caring for a sick adult is entitled to 14 days’ paid time off work per year. There are no legal provisions granting a right to unpaid time off work or flexible working hours.

The State takes over responsibility for the payment of pension contributions but only partly so that a carer can retire earlier to look after a person with dementia or any other sickness. However, each year spent caring, before one’s legal date of retirement, is calculated as if it were 7 months and not 12 months. The relevant law is the Labour Code (KODEKS PRACY).

Carers are not entitled to direct or indirect payment from the State for caring. They are not entitled to tax benefits/incentives for the care they provide either.

Bibliography

Unless otherwise stated, information provided by Mirka Wojciechowska (Polish Alzheimer Society) between April and September 2007

Ministry of Health official website (2007): http://www.mz.gov.pl/wwwmzold/index?mr= m0&ms=&ml=en&mi=535&mx=0&mt=&my=464&ma=5166 – accessed on 11 April 2007

Organisation and financing of social support to people with dementia and carers

Background information on the social/healthcare system in Poland

During the period of independence (between 1918 and 1939), a limited Bismarckian social health insurance system was introduced, covering about 7% of the population. In 1945, a Ministry of Health was created and the State took over responsibility for health care.

In the 1980s, there was a series of health reforms aimed at decentralisation. Integrated healthcare management units, known as ZOZ ( Zespól Opieki Zdrowotnej ) that had been created in the 1970s were given greater power.

However, the general health insurance act of 1997 (enforced on 1 January 1999) brought back an insurance-budgetary model of health care funding whereby the State budget was no longer responsible for funding health services. Unfortunately, there were considerable regional differences in service provision and even different prices for the same service. These and other problems with the system led to the Law on General Insurance in the National Health Fund (enforced on 1 April 2003) which established the National Health Fund. The branches of the National Health Fund are responsible for providing health services to insured people. In 2004, the National Health Fund was officially declared not in accordance with the Constitution.

There is currently very little State provision of community care services. NGOs play an important role but services are still scarce. According to Kuszewski et al. (2005), there has been a parliamentary debate about a possible role for mutual insurances for health and social care, which would include separate long-term care insurance for the elderly. Source: Ministry of Health (2007) and WHO (2005).

The organisation of social support for people with dementia and carers

There is no system of social support specifically designed for people with dementia and their carers. However, people who are ailing or need social support, because they live alone or are dependent, are entitled to receive paid (or partly paid) home help and support organised by local governments.

There are special services for the elderly but none specifically for people with dementia. The Ministry of Labour and Social Policy is responsible for social support to people with dementia/dependent elderly people. The Ministry of Health is responsible for medical services only.

NGOs are involved in various activities aimed at providing services for people with dementia and their carers. The Ministry of Health may (or may not) co-finance certain activities and tasks of NGOs, but it is up to NGOs to fight for a better quality of life for people with dementia in Poland. The private sector provides some services, e.g. nursing homes, but they are not specially designed for people with dementia.

Support from the State (mainly the Ministry of Health) is inadequate and sporadic. The amount of money that organisations apply for from the government to finance their activities, which could help people with dementia and their families cope with the disease, is much greater than what they actually receive and the amount is decreasing every year, while the number of NGOs seeking financial support is increasing. For example, to cover the costs of the awareness activities and campaigns of the Polish Alzheimer Association, it has to look for other sponsors, as the government refuses to fund such activities. Since 2004, financial support from the Ministry of Health has been provided every year but very late in the year, so the resources that are eventually granted cover a period of just 4 or 6 months. Self-help organisations also apply to local government for financial support and, as in the above situation, the money only covers 8 to 9 months. In both cases, organisations must compete for financial support.

The overall funding of social support for people with dementia and carers

Social support for people with dementia and carers is funded through general taxation and an obligatory health insurance. In addition, people are asked to contribute towards the cost of any services they receive.

The legal framework surrounding the provision of social support

Certain articles of the Polish Constitution of 2 April 1997, covering economic, social and cultural freedoms and rights, could be of relevance to the provision of social support to people with dementia. For example:

Article 67

  • A citizen shall have the right to social security whenever incapacitated for work by reason of sickness or invalidity as well as having attained retirement age. The scope and forms of social security shall be specified by statute.

Article 68

  • Everyone shall have the right to have his/her health protected.
  • Equal access to health care services, financed from public funds, shall be ensured by public authorities to citizens, irrespective of their material situation. The conditions for, and scope of, the provision of services shall be established by statute.
  • Public authorities shall ensure special health care to children, pregnant women, handicapped people and persons of advanced age.

( http://www.sejm.gov.pl/prawo/konst/angielski/kon1.htm )

Other relevant legislation includes:

  • The Social Welfare Act of 12 March 2004 (Ustawa nr 64 z dnia 12 marca 2004 o pomocy spo?ecznej)
  • The Psychiatric Act (Ustawa o ochronie zdrowia psychicznego z 1994 r. - Dziennik Ustaw nr 111, poz 535 wraz z pó?niejszymi zmianami)

The Polish Alzheimer Society is not aware of any reforms underway which might eventually affect the level of support provided to people with dementia and their carers. It does not feel that people with dementia and their carers are the focus of the current government or MPs.

The suitability of social support for people with dementia and carers

Adequacy and accessibility in general

Social support for people with dementia and carers is neither adequate nor accessible. In fact, it is not generally available at all. The situation is very difficult especially in rural areas. Larger towns, where Alzheimer associations have been set up and are active, help people with dementia and their carers make use of the existing services available to the general public. The problem is that although general care services should be available to everybody in need, they are actually only accessible to low-income families.

Unfortunately, the available services do not meet the needs of people with dementia. Home helpers responsible for providing care at home are rarely qualified or properly trained to understand the needs of people with dementia. Family carers who are members of the Polish Alzheimer Association are often responsible for training the professional carers themselves.

People living in rural areas

As stated above, the provision of social support is especially difficult in rural areas. Services such as assistance with personal hygiene, day care centres and counselling for people with dementia are particularly difficult to find.

People with different types of dementia

As there are no services specifically designed for people with dementia in general, there are none for specific types of dementia either.

People from ethnic minorities

There are no specific services for people with dementia and carers from ethnic minorities.

Younger people with dementia

Age does not seem to be important as if a person has been diagnosed with Alzheimer’s disease, he/she has the same rights to use available services, especially if he/she has been granted the status of dependent person. However, there are no services specifically designed for younger people with dementia.

Services and support for people with dementia and their carers

Types of care

Day care

Day care is partly funded by the Sate and partly by service users.

However, very few cities have day-care centres. Some are run by NGOs, others by local governments. The latter are quite rare. In Warsaw, for example, there is only one such facility yet it is estimated that at least 11,000 people in Warsaw have dementia, with only 15% having been diagnosed. The Polish Alzheimer Association considers the provision of day care totally insufficient.

A few Alzheimer associations (e.g. in Lodz, Poznan, Lublin, Torun and Olsztyn) have managed to set up day-care centres but there is always a threat that the local government will suddenly withdraw financial backing for such services.

The Church also provides day-care services e.g. in Plock, but the quality of the service is questionable and without logistic support from NGOs there is a risk, according to the Polish Alzheimer Association, of doing more harm than good to people with dementia who are usually treated like children.

Respite care

Sitting services are generally available during the day but professional carers are not sufficiently trained and the service is only available for families on a low income. Moreover, it is not specifically designed for people with dementia. There is no night time respite service in Poland.

The State may contribute towards the cost of this service and service users may also have to pay a fee for this service. This is based on the income of the whole family in a particular household.

Short-term residential respite care exists but is insufficient. Existing long-term residential homes seldom want to admit people with dementia, simply because they are afraid of not being able to cope with various problems. It is not profitable for them to allow people to stay for short periods. Generally, such institutions do not want patients to stay for less than a month. The State contributes towards the cost of short-term and long-term respite care and service users must also pay a fee.

Long-term residential care

Although there are very few long-term residential homes solely for people with dementia, there are numerous homes for the elderly and frail. On average, 30% of the people admitted to such homes have dementia. Many have no prior diagnosis. Long-term residential care is partly funded by the state and partly by service users when the person using the service, or members of his/her family, cannot cover the full cost i.e. when their income is too low. The cost of long-term care varies. A few years ago long-term care homes charged 70% of a person’s pension, however much the pension was, but nowadays, each home calculates the costs and expects the users to cover them. The local government is only responsible for covering the remaining costs in the case of very poor people.

Palliative care

Palliative care is only available for people with cancer.

Monitoring in the home via alarm systems

Monitoring in the home via alarm systems is insufficient. It is provided solely by private agencies and is not specifically designed to be used by people with dementia.

Personal assistance and home help

Personal assistance

Assistance with personal hygiene is available, especially in big towns, but insufficient. Rural areas are usually neglected. As with other services, it is not designed specifically for people with dementia. Another problem is that only people on a low income are entitled to this service. If provided, it is partly financed by the State and partly by the service user.

Assistance with mobility e.g. lifting, moving and walking and social companionship/activities form part of the social support services that are generally available but they are not specifically designed for the needs of people with dementia. Therefore, they are insufficient. These services are partly financed by the State and partly by service users.

Social community nurses from outpatient clinics in a patient’s place of residence may, if available, visit the patient and instruct the family carer on how to deal with pressure sores. The family carer may then ask the nurse again if he/she can’t cope. This is totally insufficient. Service users with a high income/pension have to pay the full cost of the service. The state partly or in some cases almost fully pays for the service for people on a low income/pension. Alzheimer associations also provide training to carers on how to deal with such problems and where to find help. The Polish Alzheimer Association arranges for nurses to visit people with dementia at home.

Some NGOs provide nursing services to people with dementia in their own homes, but this is scarce. Moreover, it is costly to NGOs and financial support from the State is difficult to obtain for this service.

Disabled people who adapt their homes are entitled to refunds from the government. This only covers part of the cost.

The following services are not available:

  1. Supervision/assistance taking medication
  2. Assistance eating and drinking
  3. Assistance dealing with incontinence
  4. Occupation therapy/ergotherapy (unless available through day care centre)
  5. Assistive devices/assisted technology

However, people with dementia are entitled to 60 incontinence pads at half price provided that they obtain a prescription for them from a general practitioner.

Home help

A few home help services are available and partly funded by the State. They include:

  1. Assistance with housework
  2. Help with the preparation of meals (incl. meals-on-wheels)
  3. Assistance with shopping

However, as these services are not specifically designed for people with dementia and only available to people on a low income, they are insufficient.

There is no laundry service and no special means of transport for people with dementia. Carers who order a normal taxi may be entitled to some discount if they can prove that the patient is disabled.

Psychosocial support and training for people with dementia and carers

There is no general service to provide information about access to services in general. The Polish Alzheimer Association has a telephone helpline.

Counselling services for people with dementia and for carers are solely provided by Alzheimer Associations. For this reason, counselling services only exist in towns where there is an Alzheimer Association and there is a lack of such services in small towns and rural areas. This is insufficient. The Alzheimer Associations do not receive any funds from the State for counselling people with dementia. Counselling for carers is partly funded by the State.

Holiday services, specially designed for people with dementia, are only available if and when an Alzheimer Association can run them. The Polish Alzheimer Association has been running such forms of respite for more than 10 years, but it is getting more and more difficult, especially when no financial support is provided by the State. The State may contribute towards the cost but many carers are still unable to afford such holidays (two weeks may cost as much as their monthly salary/pension). There are no provisions for carers to have a holiday e.g. by providing a respite carer so that the carer can have a break.

The Polish Alzheimer Association and local Alzheimer’s organisations are the sole providers of training for family carers and this is considered insufficient. The State does not, as a rule, contribute towards the cost of this training, unless the Alzheimer associations are lucky enough to receive some funds from the Ministry of Health or from the local government for educational projects.

Work/tax related support for people with dementia

There are no protective measures for people with dementia in paid employment. They are not entitled to tax refunds for employing people to provide home care services and they are not entitled to direct payments to pay for services. However, a person with dementia, like any other disabled or elderly person (i.e. over 75 years of age), is entitled to a care benefit of 150 zloty (EUR 35) per month.

People with dementia, like disabled people, are entitled to tax refunds/benefits due to their incapacity and also for home adaptations. This is based on tax legislation.

People with dementia who have been granted the status of disability of the first category (i.e. they are unable to live independently) are entitled to certain reductions e.g. on television and radio licences. Public transport (buses, trams, the underground and some trains) can be used free of charge by people with dementia and their carers. This is covered by tax law, the Acts Monitor, nr.14 of 2004, article 176 (ORDYNACJA PODATKOWA, DZIENNIK USTAW nr 14 z 2004, pozycja 176).

Work/tax related support for carers and carer allowances

According to the Labour Code (KODEKS PRACY), every spouse or child caring for a sick adult is entitled to 14 days’ paid time off work per year. There are no legal provisions granting a right to unpaid time off work or flexible working hours.

The State takes over responsibility for the payment of pension contributions but only partly so that a carer can retire earlier to look after a person with dementia or any other sickness. However, each year spent caring, before one’s legal date of retirement, is calculated as if it were 7 months and not 12 months. The relevant law is the Labour Code (KODEKS PRACY).

Carers are not entitled to direct or indirect payment from the State for caring. They are not entitled to tax benefits/incentives for the care they provide either.

Bibliography

Unless otherwise stated, information provided by Mirka Wojciechowska (Polish Alzheimer Society) between April and September 2007

 

 
 

Last Updated: mercredi 15 juillet 2009

 

 
 

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