Background information

Where people with dementia receive care and support

The following table provides estimates from Alzheimer Croatia of the number of people living at home, in various types of residential care and in hospitals or psychiatric institutions.

*The following hospitals operate psychogeriatric wards in Croatia:

• University Psychiatric Hospital Vrapče (99 bed capacity) and Psychiatric Hospital Sv. Ivan (49 beds), both in Zagreb;
• Psychiatric Hospital in Popovača (50 beds), close to Zagreb;
• Psychiatric Hospital in Lopača (90 beds), close to Rijeka.
• Psychiatric Hospitals on island Rab (43 beds) and island Ugljan (126 beds).

These institutions operate both "acute" and "chronic" psychiatric beds, according to patients' needs. The acute beds are for short stays and are associated with higher costs per day. The chronic beds, intended for longer term care, are much cheaper to operate. In spite of the much higher cost of psychogeriatric beds, the Croatian Health Insurance Fund pays the same price per bed for people with dementia and for chronically ill psychiatric patients. This economic constraint is hampering the development of psychogeriatric wards in the entire country.

In general/non-specialised residential homes, approximately 20% of residents have dementia, including undiagnosed cases. In general/non-specialised nursing homes, some 20-30% of residents have dementia, including undiagnosed cases. These percentages are based on Alzheimer Croatia estimates.

The following ratios of staff to residents are for immobilised and partially mobile patients in general/non-specialised residential and nursing homes:

• One specialised nurse for every 100 residents,
• Six nurses for every 50 residents,
• Ten caregivers for every 50 residents,
• One physiotherapist for every 50 residents,
• One social worker for every 100 residents,
• One occupational therapist for every 100 residents.

There are no specialised public residential or nursing homes for people with dementia in Croatia.

The organisation of care and support for people with dementia

Croatia does not have a national dementia plan or any special provision of care and support for people with dementia.

People who depend on another person for help (e.g. people with advanced stages of diabetes or who are immobilised after severe trauma, CVI, etc.) may apply for support from a social care centre. This is provided at a cost of approximately EUR 30-70 per month, depending on their economic status.

The majority of people with dementia are cared for by their immediate families, especially in the Slavonia and Dalmatia regions. In the central and western regions, people with advanced dementia may be admitted to public nursing homes (non-specialised for dementia) and a few private residential homes.

The public homes have significant shortages of both capacity and staff. Immobilised people with dementia have been admitted to these homes since 2007, but the number of beds is very limited.

During the past few years, new day centres in the capital Zagreb have opened as public residential/non-specialised homes or as health centres. People with dementia with severe psychiatric symptoms and behaviour disorders are admitted to psychogeriatric wards in the larger Croatian psychiatric hospitals.

Training

There is no official programme for training healthcare professionals to work with people with dementia. There is also no special training for nursing staff, auxiliary staff or allied health professionals that work with people with dementia in residential or home care.

Physicians who have completed a four-year specialisation in internal medicine may also complete a further two-year geriatric specialisation.

There are currently ten psychiatrists working in psychogeriatric wards around the country. They have varying clinical experience in working with patients with dementia but no formal education. There is also a very small number of neurologists who work with and diagnose people with dementia, but this is purely an individual choice - they do not have any formal geriatric medical education.

Support for informal carers

There is no official support for informal carers. However, carers can get some support through Alzheimer Croatia. This support relies on GPs, neurologists and psychiatrists who voluntarily provide their services to the association. Carers can also receive support from social workers, who provide information about the availability of non-specialised nursing or residential homes.

National Alzheimer Association

Alzheimer Croatia provides the following services and support:

Alzheimer Croatia has been helping people with dementia, their families and carers since 1999. The association aims to raise dementia awareness, eliminate stigma and widely disseminate the existence of support services that are available for people with dementia. In addition to the above-mentioned services, Alzheimer Croatia has also organised various lectures and participated in many meetings, conferences and congresses dealing with Alzheimer’s disease and other forms of dementia.

In 2012, Alzheimer Croatia organised the 6^th Croatian Congress on Alzheimer's disease in Primošten, one of the biggest Alzheimer's disease conferences ever to be held in Croatia. During the past eight years, the association has also organised events to commemorate World Alzheimer’s Day on the most popular squares in the centre of the capital Zagreb. (Mimica et al., 2012).

Alzheimer Croatia's work is also recognised internationally: the association is a full member of Alzheimer’s Disease International (ADI) since 2006 and of Alzheimer Europe since 2012.

References

Mimica N., Presečki P. (2010a). How do we treat people with dementia in Croatia?Psychiatria Danubina,22, 2, 363-366.

Mimica N., Presečki P. (2010b). Current treatment options for people with Alzheimer's disease in Croatia.Chemico-Biological Interactions, 187, 409-410.

Mimica N., Pecotić Z., Šimić G., Dajčić M., Trešćec-Ivičić M., Presečki P., Klepac N., Boban M., Ivkić G., Drmić S., Dajčić T. (2012). Hrvatska udruga za Alzheimerovu bolest – od osnivanja do punopravnog članstva u međunarodnim krovnim asocijacijama.Medix, 101/102(XVIII), 224-227.

Acknowledgements

Ninoslav Mimica, Head of Department, Professor and President of Alzheimer Croatia University Psychiatric Hospital Vrapče and University of Zagreb.

Marija Kušan Jukić, Psychiatrist, University Psychiatric Hospital Vrapče, Zagreb.