1. Coordinating the Network of EU Agencies 2015 Responses to the crisis in long-term care Cases: Hungary and Latvia Workshop 23 rd European Social Services Conference Lisbon, 6-8 July 2015 Hans Dubois, Eurofound http://www.eurofound.europa.eu/publications/report/2014/quality-of-life-social-policies/access-to-healthcare-in-times-of-crisis

2. Coordinating the Network of EU Agencies 2015 Long-term care Long-term care: where social and healthcare meet… Definitions and structure of ‘social’ versus ‘health’ care vary, but intuitively broadly clear Some findings from Eurofound’s study, to feed the groups discussions…

3. Coordinating the Network of EU Agencies 2015 Impact crisis on long-term care: where social & health care meet A.Demand for primary healthcare for issues which would better be addressed by social care with some reaction by creating ‘basic services’ (Portugal); B.cuts in social care: people having difficulties finding their way through the healthcare system (Slovenia)*; C.cuts in home-care for elderly: increases in hospital stay, with some hospitals reacting by increasing cooperation with social services (Ireland). Source: www.eurofound.europa.eu/publications/report/2014/quality-of-life-social-policies/access-to-healthcare-in-times-of-crisiswww.eurofound.europa.eu/publications/report/2014/quality-of-life-social-policies/access-to-healthcare-in-times-of-crisis More on the issue of non-receipt of entitlements: http://www.eurofound.europa.eu/access-to-benefits-in-times-of-crisishttp://www.eurofound.europa.eu/access-to-benefits-in-times-of-crisis

4. Coordinating the Network of EU Agencies 2015 Crisis also presented a potential opportunity Accelerating keeping older people in community Challenge 1: not need to save cost if not structurally changed, just some beds removed Challenge 2: crisis not ideal context for developing quality alternative community services Challenge 3: decreased demand for nursing homes may be caused by older people contributing with pensions to children’s household incomes Source: www.eurofound.europa.eu/publications/report/2014/quality-of-life-social-policies/access-to-healthcare-in-times-of-crisiswww.eurofound.europa.eu/publications/report/2014/quality-of-life-social-policies/access-to-healthcare-in-times-of-crisis

5. Coordinating the Network of EU Agencies 2015 Next Latvia: Mārtiņš Moors, with comments on the specific case of Stella Maris nursing home (7 min)* Hungary: Eszter Kovacs, with comments on the specific case of Platán Home nursing home (7 min)* Introducing & organising the breakout groups (5 min) Group discussions (20 min) Presenting the conclusions of the 3 groups to all (6 min) Wrapping-up * For more details on these country studies, request full country reports to Hans.Dubois@eurofound.europa.eu, or see: www.eurofound.europa.eu/publications/report/2014/quality-of-life-social-policies/access-to-healthcare-in-times-of-crisisHans.Dubois@eurofound.europa.eu www.eurofound.europa.eu/publications/report/2014/quality-of-life-social-policies/access-to-healthcare-in-times-of-crisis

6. Coordinating the Network of EU Agencies 2015 Responses to the crisis in long-term care in Latvia Martins Moors Deputy director, Head of Social Administration Riga City Council Welfare Department (member of ESN)

7. Coordinating the Network of EU Agencies 2015 Organization of nursing care home (or LTC) service for older people in Latvia Provision of nursing care home services for older people is considered to be a social service and falls entirely under the responsibility of the municipalities. However, the majority of nursing homes employ some medical personnel, mainly nurses. Provision of medical services to nursing homes’ inhabitants is organized in the same way as the provision of medical care to the general population. Long term care services for persons with severe mental disorders are under the responsibility of the Ministry of Welfare and are financed from the central government’s budget.

8. Coordinating the Network of EU Agencies 2015 Financing of nursing care home (or LTC) service for older people in Latvia Recipients of social care services must cover the cost of services or a part of it – 90% from state pension (and other income) The rest of the cost must be covered by this person’s primary guardian/caretaker (formula according to rules of government) if the guardian/caretaker is not able to do so, by the municipality.

9. Coordinating the Network of EU Agencies 2015 Sources of revenues of nursing homes, 2011 Source: Ministry of Welfare (2013)

10. Coordinating the Network of EU Agencies 2015 Actual and forecasted number of nursing homes customers, 2007-2012 Source: Ministry of Welfare (2013)

11. Coordinating the Network of EU Agencies 2015 Trends in the number of nursing homes employees, 2007-2012 Source: Ministry of Welfare (2013).

12. Coordinating the Network of EU Agencies 2015 Case study: nursing home Stella Maris Long term care centre owned by the municipality of Riga Stella Maris had long term care – In 2007, 107 customers; 53 employees – In 2011, 109 customers; 49 employees – In 2012, 114 customers; 53 employees

13. Coordinating the Network of EU Agencies 2015 Trends in monthly spending per customer, 2007-2012 (1LVL=1,42€) Source: Ministry of Welfare (2013).

14. Coordinating the Network of EU Agencies 2015 Case study: nursing home Stella Maris expenses, 2007-2012 (1LVL=1,42€)

15. Coordinating the Network of EU Agencies 2015 Actual trends now in Riga Almost half of LTC institution clients are people with dementia (46% in 2014 (Riga)) Increasing number of receivers of alternative care in living area (home care, alarm button, meals on wheels, assistant) – from 3941 persons in 2009 to 6410 persons in 2014 Increasing numbers of people with disabilities – From 40 063 persons (5,65% from Riga population) in 2009 to 47 588 persons (6,82% from Riga population) in 2014 Lack of LTC providers in Riga and surrounding municipalities

16. Coordinating the Network of EU Agencies 2015 Thank you for attention!

17. Coordinating the Network of EU Agencies 2015 The cases Latvia Hungary

18. Coordinating the Network of EU Agencies 2015 Introducing the break-out groups 3 Groups, for 20 minute discussion; chairs: 1.Eszter Kovacs 2.Mārtiņš Moors 3.Jordi Tolrà i Mabilon Each group has 1 rapporteur who will at the end summarise conclusions in Max 120 seconds Conclusions incorporated in 1-page summary of this workshop, to be posted on-line

19. Coordinating the Network of EU Agencies 2015 Questions for all break-out groups 1)What are the challenges in cooperation between social and health services in long-term care? 2)How has the crisis impacted cooperation between social and health services in long-term care? 3)Given this background, how –and in what circumstances– can cooperation between social and health services contribute to quality service delivery?

20. Coordinating the Network of EU Agencies 2015 Thank you Hans Dubois Hans.Dubois@eurofound.europa.eu