Trends, Challenges and Solutions in the Systems of Long Term Care in Norway By Karl Johan Johansen May 9,

Presentasjon om: "Trends, Challenges and Solutions in the Systems of Long Term Care in Norway By Karl Johan Johansen May 9,"— Utskrift av presentasjonen:

1 Trends, Challenges and Solutions in the Systems of Long Term Care in Norway By Karl Johan Johansen May 9, 2019 1

2 History Long-term care in all Scandinavian countries was provided almost exclusively by families. The public involvement in long-term care evolved from being aimed at poor elderly to a more general approach – 1940’s Norway was the poorest among the Scandinavian countries and enacted reforms a few years later than Sweden and Denmark. This increased reliance on the public sector was confirmed by law and enacted in Norway in 1964 when municipalities were obliged to offer care in nursing homes. In the 1960s and 1970s there were a rapid expansion of formal long- term care (LTC) services In the early nineties, private entrepreneurs were allowed into the market for long-term care. https://www.helpage.org/global-agewatch/population-ageing- data/global-rankings-table/ https://livsgledeforeldre.no/livsglede-for-eldre-engelsk/ 2

3 The LTC system in Norway and Scandinavia The LTC-system is part of a comparatively large public sector. The voluntary sector is part of public health care plans and almost completely financed through public sources. A private (profit) sector is relatively small due to lack of a market for this kind of service provision. 3

4 Levels of government The public sector is managed through three levels of government. The result of this administrative structure is a comparatively decentralized service The LTC system has small units in the hands of local authorities that are responsible to small and often scattered populations. 4

5 Type of LTC services In Norway Institutions: Nursing homes Homes for the aged Community care: Assisted living Sheltered housing Home nursing Home help Medical services as for the general population 5

6 Collaboration with non-profit organizations A tradition of contracting with non-profit nursing homes, even though public nursing homes dominate. Often owned and run by a religious or humanitarian organization. A contract implies that their patients have been entitled to care similar to patients of public services. Very few for-profit companies are involved in publicly financed LTC in Norway. 6

7 Funding of services The Scandinavian systems for financing long-term care are remarkably similar Norway has a tax-based, universal public long-term care (LTC) scheme. LTC is funded both by national and local taxation. The system is funded by national taxes but carried out at local level, and may require co-payments depending on the care required Municipalities are free to set co-payments within legal boundaries: The patient must pay 75% of income above a certain level 7

8 Universalism vs. strong local autonomy in LTC Two fundamental principles of the Scandinavian model appear to collide: the universalism with strong local autonomy. The financing long-term care is a compromise Municipalities have freedom in designing local policies, but the government can intervene to assure the comparable standards throughout the country. 8

9 Public spending on long-term care in % of GDP 9 Source: OECD Health Statistics 2018.OECD Health Statistics 2018 x x

10 Increase in the old-age vs, working age population from 2005 and 2050 10 x x

11 Challenges for Norway regarding LTC First, the proportion of the population aged over 80 years will rise to 9% by 2050, and a concurrent rise in adults with chronic health condition, such as diabetes, heart disease or cancer, is to be anticipated. Second, there have been shifts in the way health care is provided. Average length of stay in hospitals (ALOS) has dropped from 8.9 days to 6.8 days in Norway, in line with a trend seen across OECD countries. Norway has some of the shortest hospital stays observed in the OECD. 11

12 DMC – District Medical Centers In Norway we have established primary health care units - “Districts medical centers” which are taking care of patients upon discharge from hospital, or where there is a risk of admission to hospitals, when the condition could be appropriately they are taken care of at a lower intensity setting. These units are service models for integrated care, financed jointly by hospitals and municipalities, for patients with intermediate care needs and supplement primary health care 12

13 Transforming and improving the model The evolution of modern Norwegian LTC services has followed shifting trends in national policies. These policies have been highly incremental. And when new goals have been set, they have been fairly global. This is also the case with policy measures. By and large, the repertoire of measures mostly has consisted of shifting general administrative and/or financial frameworks for the provision of services. 13

14 The Coordination Reform The reform also gives more emphasis to the effective management of LTC through better care co-ordination between the health and other social sectors. The introduction of the economic incentives are excellent drivers for the setting up of supplemented primary health care units. These financial incentives aim at increasing co- operation between primary care and specialised health care services, The success depends also upon the development of information infrastructure, the setting up of standards, and the enhancement of municipal capacity. 14

15 The service users and their relatives are getting more influence It is increased focus upon making use of the users’ resources in new ways, with greater focus on mastery and the individual’s experiential knowledge as the basis for service development. User involvement should be increased on at least three levels: At the individual level in relation to influence over one’s own life situation and the services available; At the group level in relation to meeting, sharing experiences with and supporting others in the same situation; At the municipal and societal levels through patient and user representation. In addition to the provisions set out in patients’ and users’ rights legislation, the Government has implemented a number of measures that more directly help to enhance the patient’s position and influence at these three levels: 15

16 INDIVIDUAL FREEDOM OF CHOICE AND INFLUENCE Norway has implemented measures that aiming at: increased freedom of choice accessibility and flexibility, strengthen information, and improve communication between providers and recipients of the services. individuals opportunities to shape the combination of services, take decisions and influence the course of treatment, and share responsibility rehabilitation or treatment. greater freedom to choose their service providers and the form and content of the services. more use of welfare technology, telemedicine and new technological solutions for information and communication are included in this as well. 16

17 FROM INVOLVEMENT TO PATIENT AND USER CONTROL Professionals and users are invited to design together the health and care services of tomorrow. Users and their close family members are incorporated in designing measures to create a more dementia-friendly society. The process is also based upon a broad consultative review. 17

18 AN ACTIVE, FUTUREORIENTED INFORMAL CARE POLICY The objective of the programme for an active, future-oriented informal care policy is to: draw attention to, acknowledge and support family members who perform demanding caregiving tasks; improve coordination between the public care services and informal care, and enhance the quality of the overall services available; create a framework to ensure that the current level of informal care is maintained. 18

19 The care services of tomorrow The care services of tomorrow must create services together with the users, cooperate with family members and mobilize local communities in new ways. We also have to utilize welfare technology and create new and better adapted architecture for a better live in LTC.

20 Thanks! karl.Johansen@kbtmidt.no karl.j.Johansen@ntnu.no