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Care aspects

2020: European Dementia Monitor, Comparing and benchmarking national dementia strategies and policies

2 Care aspects

2.1 Care Availability

2.1.1 What did we look at and why?

In line with the 2017 Dementia Monitor, the survey sent to members asked about the range of services that support the quality of life and care of people with dementia throughout the course of the disease from mild to advanced dementia. The list was reviewed by national member organisations in 2019, who felt it remained a comprehensive list of services which were vital to the health and wellbeing of people with dementia and their carers.

Most home care services can be roughly divided into two categories: those providing assistance linked to a person’s residence (e.g. cleaning, shopping, laundry, transport, meals-on-wheels etc.) and those linked to personal care (washing, dressing, eating, incontinence care, getting in and out of bed, taking medication etc.).

In line with these measures to help keep a person at home, services such as assistive technologies and adaptions to the home were included. However, it was also noted that residential care and end of life care would play a significant role for some people with dementia, and as such, these were also included within the list. Furthermore we looked at the needs of carers themselves and services such as respite care that can reduce the impact on caregivers.

The following 18 care services were identified by Alzheimer Europe members as having the greatest significance:

  1. Care coordination/Case management
  2. Home help
  3. Meals on wheels
  4. Incontinence help
  5. Assistive technologies / ICT solutions
  6. Tele Alarm
  7. Adaptations to the home
  8. Home care (Personal hygiene, medication)
  9. Counselling
  10. Support groups for people with dementia
  11. Support groups for carers
  12. Respite care at home (sitting service etc)
  13. Holidays for carers
  14. Carer training
  15. Alzheimer Cafés
  16. Day care
  17. Residential/Nursing home care
  18. Palliative care

Alzheimer organisations and national experts were asked to indicate whether they believed these services were sufficiently available (S), insufficiently available (I) or absent (A) in their country.

2.1.2 Results

The detailed answers regarding the availability of care services can be found in table 2.

As with the 2017 Dementia Monitor, the majority of care services in Europe continue to be insufficiently available.

However, an increased number of countries reported 50% or more of the aforementioned services being sufficiently available in their countries including: Austria, Belgium (including Flanders), Denmark, Finland, Germany, Israel, Jersey, Luxembourg, Netherlands and Sweden. This is an increase on the 2017 Dementia Monitor.

None of the care services we looked at were reported as sufficient in Bulgaria, Greece, Ireland, Latvia, Lithuania, Poland, Portugal, Romania, Turkey and the United Kingdom (both England and Scotland). This is a slight increase on the 2017 Monitor.

As per Figure 1, the types of services rated as sufficiently available varies considerably, with incontinence help being rated as sufficiently available in 20 countries (out of 36), with care coordination (four countries) and assistive technologies (five countries) having the lowest availability.

Broadly, the number sufficiently available services has improved across Europe, compared to the 2017 Dementia Monitor. Incontinence help, meals on wheels, home help, counselling, support groups for carers, Alzheimer cafes, day care, support groups for people with dementia, palliative care, respite at home, and holidays for carers, all showed increases in the number of countries rating these services as sufficiently available (since 2017).

By contrast, home care, assistive technologies and care coordination showed a decrease (from 2017) in countries reporting sufficient availability. All other services showed no change.

From these figures, there are both positive and negative conclusions which can be drawn in relation to care availability in Europe:

  • There has been an increase in the number of countries where the majority of services are considered as being sufficiently available
  • The majority of services have shown an increase in the number of countries reporting that they are sufficiently available
  • With the exception of incontinence help, all other services have a majority of countries which report that these services are inadequately available or absent
  • A majority of countries continue to report that most services are insufficiently available or absent.

The maps show the differences in availability of key support services across Europe. From Map 1, it is obvious that home care is primarily available as a service in some Western and Northern European countries, whereas it is insufficiently available elsewhere. Day care, as indicated in Map 2, is primarily considered sufficiently available in European countries with smaller populations, although Germany was an exception to this. Similarly, residential care was mostly considered as being sufficiently available in countries with smaller populations, as can be seen in Map 3.

2.1.3 How did we score countries?

Countries could score a maximum of 36 points. For each of the 18 services, countries were scored 2 points if the service was ranked as sufficiently available, 1 point if it was ranked as insufficiently available and 0 points if it was not available at all. Based on the results, it is possible to rank European countries as indicated in figure 2, which shows the points expressed as percentages of the maximum possible score.

2.2 Financing of care services

2.2.1 What did we look at and why?

In addition to identifying which services were available in European countries, it is important to find out how accessible these services were for people with dementia and their carers. For that reason, national member organisations and experts were provided with the same list of services as in the previous chapter and asked whether these services were fully funded (F), co-funded or means tested (C) or whether people with dementia and their families had to self-fund (S) to access these services.

2.2.2 Results

The detailed answers regarding the financing of care services can be found in table 3.

Compared to the 2017 Dementia Monitor, there is little change in the way in which services and supports are funded within European countries.

Very few countries provide full funding for the majority of services, with Denmark, Finland, Malta and Norway being the only countries which have 50% or more of services being fully funded (the same number of countries as 2017). By comparison, there are a significant number of countries in which 50% or more of services are self-funded. This is the case in Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, Greece, Italy, Latvia, Poland and Romania.

There has been an increase in the number of countries providing some level of support for assistive technologies, tele alarms, meals on wheels, adaptations to home, counselling, carer training, incontinence help, residential care, palliative care and day care. Conversely, fewer countries provided funding for holidays for carers, Alzheimer cafes, support groups for people with dementia, respite care, support groups for carers, home helps and home care. There was no change in the level of funding for care coordination.

Figure 3 provides a breakdown, by service, of the number of countries which provide some level of public funding for specific services. A majority of countries provide full or co-funding for the majority of services, with holidays for carers, assistive technologies and Alzheimer Cafés the only services for which a minority of countries provide some level of funding.

The most commonly publicly funded services included day care, palliative care, incontinence help, home care and residential care. Conversely, holidays for carers and assistive technologies were some of the least supported by public finance.

As in the previous section, the picture is mixed in relation to how services are funded:

  • The majority of services continue to be funded (at least in part) in the majority of countries
  • The majority of services showed an increase in the number of countries providing some level of funding
  • Disappointingly, a significant number of countries (9) have a majority of services services (50% or above) which are self-funded.
  • Some services show a reduction in support from the state compared to 2017, including support groups and Alzheimer cafes.

2.2.3. How did we score countries?

Countries could score a maximum of 36 points. Countries were scored 2 points if the service is fully funded, 1 point if the service is co-funded or means tested and 0 points if the service has to be self-funded or if the service is not available in the country. Based on the results, it is possible to rank European countries as indicated in figure 4, which shows the points expressed as percentages of the maximum possible score.

 

 
 

Last Updated: Tuesday 30 March 2021

 

 
 

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