The Home Care Service:Recognizing Mistakes,Rational Principles and Perfecting Measures
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The home care service is the core and basement of the social care service system,but there exists some misunderstanding.The theoretical basements of its perfection are theories of the suitable universal welfare,the equality of basic public service and pluralism of welfare.The transformation from organization to home care service and its supporting policies in other countries give the experience basement for its perfection.We should respect the selection of the aged,guarantee their living level and recognize the common responsibility among the family,society and government.The basic position of self help,the home care service,the helpful position of communities and apartments and the support of government and societies are its rational principles.We must define correctly the basic relation and suitable ways of the home care service,establish government supporting policies and improve the basic condition.Keywords:
Perfection
Pluralism
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Transportation has often been an afterthought in federal health care provision. This article looks at today's health care reform plans and assesses how transportation industry might fare under both present and proposed policies. The authors emphasize that any attempt to provide long-term care should include transportation not only as a specific service but to bolster all other components of community-based care. The article also states that in a comprehensive, regionally based health care system, an allied community public, private and nonprofit transportation network should provide the vital links between people and medical services, as any health care system is of absolutely no use to people unable to access and benefit from the services.
Community Health
Medical care
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Introduction: The Swiss Red Cross (SRC) is supporting local partners in Eastern Europe/CIS in developing services to allow elderly a dignified ageing in their homes. SRC promotes integrated medico-social home care services in agreement with the local partners, their strategies and capacities. “Help to self-help” is crucial besides the provision of good quality low cost services, accessible for people in need. In many post-Soviet countries, cooperation between Health and Social Ministries is rather weak. Access to health/social care services is a challenge for older people due to low pensions, lack of transportation means and low self-mobility. At policy level, the SRC facilitates the collaboration between health/social care policy makers and fosters exchange with advisory boards or working groups. At practical level, the SRC links medical and social care workers and puts a model of nurse-led care into practise.Objectives:- Strengthening health care systems and enabling access for all,- Engaging in advocacy for health and social inclusion,- creation of workplaces for nurses and new profession of home-helpers/care assistantsResults: In all six SRC partner countries, SRC and parners gathered their experiences:The health and social needs and type of services to be provided needs to be confirmed by in depth surveys/assessments and to be demand-driven, with user- and provider integration.In all five countries, approx. 12’000 elderly, chronically ill persons are cared for by 60 home care centers[1] and authorities (local, national) are co-funding.The existing legal framework is an important factor when considering sustainability issues.Integrated medico-social home care services are nurse-led/managed services in close cooperation with General Practitioners and stationary public services. Many countries accept only medical doctor led services for reimbursement. Promoting nurse-led services requires a shift of paradigm and changes in legislative frameworks. This requires evidence based advocacy to withstand the strong doctor’s lobby.The continuous training of home care staff is crucial, particular in quality of care, in dementia and palliative care issues. Countries lack legislation, regulations and guidelines in how to care for such persons. Home care staff often are the only persons taking care of patients, living alone, with dementia or being terminally ill.In 2013, the SRC and partners established their knowledge management group with all six partner countries. The aim was to analyse different home care models and define core areas for cooperation. To learn from each other bears many advantages. Successes in one country encourage others to work and advocate for positive approaches. Exchange also involved peer-trainings, peer-coaching and peer-reviews as well as peer-evaluations, mainly in 2015-2016. Based on the exchange, once a year a meeting in one of the project countries including field visits and every 2nd month discussions in skype-meetings proved to be effective. Hence the SRC has a community of practice established for the knowledge-management group in Home Care, Active and Healthy Aging on its intranet. Uploading and screening of applications, reports, evaluations is a common practice nowadays in the network between the six countries. In order to compare outcomes and effects in Home Care the SRC introduced core-indicators for measuring of the Outcomes in all six project countries and elaborated as well a toolbox (result chain) for home care. Thus, all members (SRC delegates in the countries and partner organisations) are involved in Knowledge-Management and sharing. This approach used to satisfying, efficient, effective and improved the quality of the work enormously.Evidence of functioning of the Home care model: Before any activity is started, sound and serious data collection is needed with surveys/studies and scrutinizing the existing policies, strategies, road-maps in a given country related to community health and social services. Important in the work of the Swiss Red Cross as humanitarian organisation is the aspect of vulnerability. Thus, the vulnerability capacity assessment (VCA) is one tool measuring the scale of vulnerability in different areas (economic; social; health; mental; livelihood; water etc). Focus-group discussions, household surveys, needs studies etc are part of the assessment in cooperation with the partner organisation and very often Government agencies and other international or national NGO’s in a chosen country. Thus Home Care services are not build up based on a “wish-list”, but on evidences in the given country.Scalability and sustainability of the Home care model: In all six SRC countries in Europe/CIS, the partners are mostly the national, local Red Cross/Red Crescent Societies. In the West, RC/RC Societies often work auxiliary to Governments. This is not given in the countries where former socialist or autocratic systems were in place. Home based Care is a new issue in all these countries – thus before such model is adopted within the official health and social care system, SRC and partners have to extensively lobby and work evidence-based with operational research tools to show the gap in the public service provision, the need to have new quality, cost-efficient and effective care models for the growing parts of vulnerable populations not able to “pay-out-of pocket” and thus not having even access to basic services.12’000 clients in 6 countries in 4 ½ years of work is a step forward in systems, that not think integrated and in interfaces and where health and social areas are strictly separated. Hence only in Moldova a small funding for “nurse led” home services are paid by the national Health Insurance Fund. In all other countries, either HIF is not existing (Semashko-system) or onlydoctor-led services are funded and thus, changing of mind-sets in people and across the cultures is needed – behaviour change needs time. Nurse-led services present a change in paradigm in all these countries and cultures. Thus, social authorities and family doctors/general practicioners, Policlinics/hospitals, specialist doctors ought to be step-by-step taken on board as partners. Not the competition on sometimes scarce funding in some countries should be the issue, but to build a case- and care-management and referral system. The aim is:The General Practitioners/Policlinics/Social Workers & the Home Care staff form one “Care” Team with one goal: to improve the health and well-being of the client;The information about the client is with all partners/stake-holders in the system (e.g. patient card);Functional up and down-referral system is developed within the state/public systemIn addition, to scale up, replicate and achieve sustainability changes in existing health/social care laws are needed (funding follows laws), regulations changed, new professions introduced e.g. Bulgaria: social care assistant (home helper); Bosnia/Herzegovina: care assistant. Quality standards for Home care centers and for a national minimal quality standard in Home care for Not-for-Profit-Organisations introduced; post-graduate trainings for nurses defined and accredited; volunteers found, trained and retained; paid services introduced i.e. multifunding approaches elaborated; benchmarking/costing study introduced etc.Taking all in mind, we may even speak of a partial reform in “Primary health care/ Community health and social care”. Before Governments are not ready to change for such new model scalability ought to be planned but the numbers of clients kept lower in order to not create new dependancies on external fundingWe know from “Community based home care provision” in Switzerland, Austria and Germany that for building such a service a minimum of 15-20 years of continuous processes is needed in a stable economic environment.Referenses:1- By professional nurses, home helpers, care-assistants, volunteers.
Integrated Care
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Home-based care service is a mainly trend of the pension services development.It's impotent to deal with population aging and the construct of harmonious socialist society.Home-based care service is integrated multiple dimensions:living in families in which the basis of position to assume the supply of basic goods and the spirit of old-age function;the communities in which in relying sexual status,and commitment to the elderly community participation,social participation,recreation and leisure,and psychological adjustment learning and consulting needs,the market in a complementary position,the main needs of the elderly higher,more professional level of demand.Only based on the actual needs of the elderly,the combination of the three,and build mutual support multi-service system,in order to truly realize the progress of home-based care service.
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Sweden's extensive eldercare system emphasizes home and community-based care provided by municipal government. Recent policy reform is designed to improve the provision and coordination of long-term care by transferring the responsibility and resources for the health care component from regional to local government. Policy designed to help older people manage at home has emphasized formal care, but support for family caregivers is now receiving increased attention. Care managers in municipal eldercare are responsible for individual client need assessment and level of care determination. Recent reforms in service provision combined with a weaker economy in the 1990s have increased the importance of the care manager's role in Sweden. Many municipalities are now testing new forms of service delivery that focus on the roles of care managers. These include a purchaser-provider model in which the care manager decides on a package of care and purchases some of the services from private or public providers. Under this system the care manager has increased responsibility for monitoring outcomes and determining how resources are used more effectively.
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Different from the traditional family supporting model for the aged,the social old-age care service,as a new supporting system,is under directional reconstruction in China,whose basic framework is embodied as a type integration of old-age care service systems.To boost the development of China’s social old-age care system,it is essential that diversified subjects of legal responsibility should be coordinated,multi-level classified administration should be realized and professional old-age care service should be provided.Accordingly,the corresponding policies should be oriented towards the social old-age care service system’s framework construction,operation mechanism improvement,preferential policy implementation,investment increase and so on.
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What follows are some steps taken by Nanjing City in conducting community health care: changing traditional concepts so as to meet the needs of the masses, strengthening work in organization and leadership so as to draw up good plans, rationally utilizing health resources so as to set up service networks, and conducting training of general medical practitioners and exploring two way referrals so as to perfect community health care. The authors hold that at present there are some problems needing prompt solution in community health care and thus put forward the following suggestions: striving for state and government support, formulating relevant supporting policies on the conduction of community health care, setting up a corresponding system of rational compensation, strengthening the cultivation of general medical practitioners, and standardizing the management of community health care.
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Something valuable can be learned from family care conducting models of such developed countries as Britain,American Australian and Japanese Introduce.Drawing on the experience of the countries,the paper suggests that when delivering family care services,China's population and family planning technical system should provide family health care service by taking public health conception based on primary health and health fair as the basis,and residents' needs as the focus,and by mobilizing all human resources which centered by general practitioners and nurses.The government should guarantee the relating fund supply and build monitoring and managing mechanism.
Family health
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The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.
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The Canada Health Act guarantees access to medical care for all Canadians and outlines a funding mechanisms for achieving this goal. However, it also entrenches patterns of authority and service models which reflect a hierarchical model of health care. Using the field of home care, it is argued that health structures enshrined in current legislation will actually impede the development of alternative types of service and organizational arrangements needed to meet the needs of future elderly Canadians requiring health care in their homes.
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Restructuring
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