Denmark

Demographic information (Database)

• Inhabitants: 5,560,628 
• No. of citizens 65+: 933,523
• No. of citizens 75+: 390,797
• No. of people with long-term care needs:  179,900 (65++ in assisted living or own home)

Characteristics of health, social and long-term care delivery

Since 2007 prevention and rehabilitation services in Denmark have been undergoing a major change process in terms of organisation, management and delivery. A nationwide local government reform came into force on 1 January 2007. The aim was to provide a better basis for ensuring cohesive patient treatment, and simplified access to prevention, examination, treatment and care. Local authorities became the gateway to the public sector and thereby took on a considerably stronger role in health and social care. Five new regions became responsible for the health sector, i.e. hospitals, psychiatric treatment and the Danish Health Security. The regions provide a platform for planning and enhancing quality. Local authorities are still in a phase of transition. They now play a more frontline role, as they have become responsible for all health promotion, prevention, training, care activities and rehabilitation not performed at hospitals. In particular with regard to retraining and rehabilitation, one of the overt reasons for assigning sole responsibility to local authorities was to reduce the occurrence of ‘grey zones’ when patients move from the secondary to the primary sector (Ministry of Social Affairs, Taking care of elderly – The Danish way).

However, a major challenge for Denmark and many other EU countries is that the number of older people in need of care is growing, while there are fewer adults of working age to provide and finance this care. The Danish welfare state is stretched in its attempts to recruit and retain an adequate workforce that will ensure essential welfare needs are met and at the same time secure continued high levels of service. The future economic viability of the care sector rests on the urgent development of resource-saving interventions, to generate further knowledge about the most effective and efficient methods and to exchange research and results.

Background information on key-issues

Prevention and rehabilitation in LTC

(...) The background to any study of long-term care for older people in Denmark is the major sea change in housing and care for older people that began in the 1980s. The Skaevinge Project (Wagner, 1997) fundamentally and radically shifted Denmark’s entire approach to long-term care, and the principles have since been adopted in countries as culturally varied as Japan and Canada. At the centre was the dismissal of the concept of traditional nursing homes, where care and accommodation were provided as a package. With the separation of housing and care functions there came a raft of changes: rooms were converted into homes, older people retained their individuality and the notion of self-care became central, 24 hour care by inter-disciplinary teams was adopted and crucially, instead of pocket-money older people could now keep their pensions and make decisions about the kind of care they preferred. All developments since then have been based on these earlier initiatives (more ...)

Governance and financing of LTC

(...) The background to how long-term care for older people in Denmark is governed is the major sea change in housing and care for older people that began in the 1980s. Denmark had long upheld the tenets of the so-called ‘northern social-democratic welfare regime’ (Esping-Andersen, 1990). But it was the results achieved by an action research project at local authority level in the nineties that brought about radical and permanent changes to Denmark’s approach to long-term care (Wagner, 1997; WHO report, 2009). At the centre was the dismissal of the concept of traditional nursing homes, where care and accommodation were provided as individual packages. With the separation of housing and care functions there came a raft of changes, including 24 hour care by inter-disciplinary teams and a drive towards self-determination, where older people could now keep their pensions and make choices about the kind of care they preferred. Developments in the structure and national administration of long-term care continue to be influenced by this national shift in thinking that was brought about by a bottom-up approach. One of the many last consequences is that there is no longer a concept called ‘institutionalised care’ in Denmark. Even very frail people who live under one roof have their own apartments and receive ‘home care’. Hence in this report all reference to the living situation of older people will refer to ‘older people’s housing’ and not ‘institutionalised care’ (more ...)