2005: Home care
Legislation relating to the provision of home care services
In the Flemish speaking part of Brussels and Flanders, the “zorgverzekering” is the relevant law governing the provision of care services at home and in institutions. It came into force on 1 October 2001. This does not exist in the Walloon region but it is being discussed.
According to the degree of dependency of the person concerned, s/he can receive a fixed amount “A” (least dependent), “B” or “C” (most dependent) for the financing of home care services (federal legislation). The criteria to determine the fixed amount are based on the capacities of the person (e.g. related to getting dressed, moving, incontinence and feeding).
Also at the federal level, there is the health care insurance (which has been improved) and the allowance for assistance to the elderly (which has also been improved).
Adult children are not legally obliged to care for their parents. However, if a parent or in some cases a grandparent needs residential care, the local Public Centre for Social Welfare can claim part of the costs back from the children and exceptionally the grandchildren provided that they have sufficient resources (Declercq and Van Audenhove, 2004).
There is no specific policy for people with dementia. Measures are taken within the framework of financing of long-term care for dependent people. There are also several allowances for handicapped people:
- the income replacement allowance (for people between 21 and 65 years of age): granted if earning capacity is reduced to 2/3 of what a valid person is able to gain on the labour market.
- the integration allowance (for people between 21 and 65 years of age): if, due to reduced autonomy, the person is faced with additional expenses for integration in social life.
- the allowance for assistance to the elderly (over 65 years of age): if, due to reduced autonomy, the person is faced with additional expenses for integration in social life.
Organisation and financing of home care services
Nursing home care is financed by health insurances but people may be asked to pay a supplement for certain services offered by freelance nurses. Palliative care and end-of-life care at home are also free but necessitate a prescription from a doctor. A payment of two instalments of EUR 483 may be charged for the hire of equipment and for medication.
Sitting services (which may also offer respite for carers) are not covered by the health service. Therefore there are no set fees and such services are often costly for patients/carers e.g. EUR 18-32 per night and EUR 11-20 per day depending on the patient’s needs.
The situation regarding home care services (e.g. help accomplishing certain tasks linked to daily life such as doing the shopping, preparing meals, household tasks and personal hygiene) depends on one’s place of residence. In the French and German speaking part of Belgium, such home care services are coordinated and registered. The contribution to be borne by the person requiring the service is means tested but it is also possible to apply to health care insurances for assistance. In the French speaking part of the country, home care services are chiefly regulated by the Decree “Picque” of June 1989, which regulated the establishment and functioning of “centres for the coordination of care and home care services” (Declercq and Van Audenhove, 2004).
In the Flemish speaking part of Belgium (in Brussels and in Flanders) there is the “zorgverzekering” which covers care services at home and in institutions. It is obligatory in Flanders and optional in Brussels. It costs EUR 25 per year and entitles people at home to a payment of EUR 90 per month and people living in an institution to a payment of EUR 125 per month (provided that they fulfil the necessary criteria for payment). “Community care centres” exist in the Flemish part of Belgium, which provide a meeting place for people over 55 and those in need of home care. The idea is to provide information, prevent isolation and make professional care more accessible (Declercq and Van Audenhove, 2004).
In 2004, the government introduced “service cheques”. The cheques are for € 6.20 per hour of help and are tax deductible for the person who purchases them. They can cover in-house activities such as ironing, cooking and cleaning or outdoor activities such as shopping and transportation (Declercq and Van Audenhove, 2004).
For the refunded services, a personal quota (known as a moderating ticket) is borne by the person insured. In 2001, the principle of the “maximum to invoice” was established. It fixes an absolute limit that families should have to pay per year in moderating tickets for essential refundable care. This limit is fixed according to the income of the family.
Kinds of home care services available
The kinds of services that are available include home help, sitting services, respite care, day care centres and night care centres etc.
Private and public organisations provide meals services.
Some local authorities organise other forms of help such as transportation and shopping. Such services may be provided by voluntary organisations, municipalities or non-profit organisations (Declercq and Van Audenhove, 2004).
- Declercq, A. and Van Audenhove, C. (2004), National Background Report for Belgium, EUROFAMCARE,
- http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/ nabare_belgium_rc1_a4.pdf
- Delpérée, N. (2004), Les aspects sociaux, juridiques et éthiques en cas de démence, Ligue Alzheimer
- Information provided by a member of the Scientific Council of the Ligue Alzheimer.
Last Updated: Wednesday 15 July 2009