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Quality assurance of long term care for the elderly in Italy Walter Lorenz.

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Presentation on theme: "Quality assurance of long term care for the elderly in Italy Walter Lorenz."— Presentation transcript:

1 Quality assurance of long term care for the elderly in Italy Walter Lorenz

2 Social Services in Italy State of transformation Ambiguity between –Holding on to traditional patterns –Modernisation Overall: –Expansion and consolidation –decentralisation

3 Quality control regulations Largely a matter for the regional authorities Uneven concepts and regulations No vonvergence of standards

4 Motivation for quality control higher degree of establishment and professionalisation of social services growing user expectations for improved and more specialized services fiscal restraints which necessitate the efficient use of limited resources curb on the uncoordinated growth of non- governmental services financed publicly public demands for greater transparency in the light of the tangentopoly scandals

5 Basic requirements (law 328/2000) Authorisation (law 381 of 1991) – examination of basic suitability to receive state funds (mainly structural) Accreditation (regional draft laws) – service-specific structural and operational criteria User choice (vouchers and care allowance) Service Charta

6 Italy, demographic profile (tendencies 2000-2030)

7 Quality concepts No agreed national standard of quality of care for the elderly criteria of structural and of process quality dominate over outcome quality indicators Legislation so far covers structural and organisational indicators

8 Quality requirements and standards National organisation: ‘Società Italiana per la Valutazione e Revisione della Qualità dell’assistenza’ (VRQ) – recommends: –yearly or triennial operational plan for the institution in which intended activities are listed –correct and transparent financial affairs –conformity with statutory requirements for safety, employment and the management of social and health services –conformity with regulation on professional qualifications of staff –conformity with criteria for the allocation of pubic funds

9 Structural standards (Decree DPR 14/01/97) –Number of beds not less than 20 and not more than 120 –Bedrooms to 1,2,3 or 4 beds but in each case guaranteeing a private space –Hygienic services suitable for persons who are not self- sufficient –Suitable kitchen facilities –Common day facilities with games, TV etc. –Cupboards for clean bedding –Separate depositories for used bedding –Adequate toilet facilities –Store room for walking aids etc. –Aids for non-independent users such as adjustable beds, special mattresses, walking aids, lighting, oxygen supply, emergency call systems etc. –Rooms for medical treatment –Rooms for rehabilitation activities

10 Organistional aspects Services in the agency must, in coordination with external available services, guarantee efficient support for physical, cognitive, psychological and social needs of residents The agency must furnish an individual assistance plan for each resident that corresponds to the needs identified Data on residents and treatment need to be collected so as to be available for inspection The participation of the family of the resident must be ensured

11 Personnel requirements o Director of services o Medical director o Physician for diagnosis and treatment o Access to specialists like geriatric specialist, dentist, psychologist etc. o Nurse o Physiotherapist o Animator o Social assistant / social pedagogue

12 Charta of Services should contain o Presentation of the agency and its fundamental principles o Information on structure and services provided o Quality standards applied and programmes instituted o Mechanisms that allow users to exercixe their rights such as privacy, access to information and complaints procedures as well as information on verification procedures It should normally be accompanied by a list of regulations for the institution

13 Quality Management –Quality control and certification agencies in Italy need themselves be accredited with SINCERT (‘Sistema Nazionale di Accreditamento orgamismi di certificazione’) Each such agency only covers a specific sector, in this case the sector ‘assisted residential institutions’ (Residenze Assistenziali) and can be accredited only if it has successfully issued 3 certificates. –The most commonly used instruments for quality control are the norms of ISO 9000. These norms, in their European version, have been further modified and specified by an Italian body, the ‘Ente Nazionale Italiano di Unificazione’ (UNI). It organizes quality criteria in 4 categories UNI EN ISO 9000 – general criteria in the sector UNI EN ISO 9004 – guidelines on the efficient application of Quality Systems UNI EN ISO 9001-3 deal with specific agency functions and requirements

14 UNI EN ISO 9000 (Italy) –Orientation on achievable outcomes for seniors –Formulation of specific objectives for seniors –Identification of suitable instruments for evaluation –Special responsibilities of the directors of institutions –Details on information systems –Documentation for admission procedures –Central role of the management of human resources (avoidance of burn-out among staff, career planning and in-service training, staff satisfaction) –Control instruments of service delivery –Evaluation of complaints and of compliance

15 Quality enhancement (future) Law 328/2000 has initiated a process of quality enhancement and the development of national instruments and procedures for monitoring. In particular through the provision of vouchers and care allowances it gives users of services a measure of direct influence on the development of quality indicators. The process is assisted by the work of various national organizations such as Società Italiana per la valutazione e revisione della qualità dell’assistenza (VRQ), Ente Nazionale Italiano di Unificazione UNI and SINCERT, Sistema Nazionale di Accreditamento organismi di certificazione – settore: Residenze Assistenziali

16 Barriers Tensions between politics of centralization and regional autonomy which have not been resolved Over-abundance of legal prescriptions and regulations which are hard to coordinate An under-developed culture of consumer rights and a corresponding fatalism in the light of impenetrable bureaucratic obstacles Uneven processes of professionalisation in various sectors of the health and social field.

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