Greek Care Homes Association (PEMFI)

Why was this example implemented?

PEMFI was implemented as an initiative of the directors of all legally registered care homes in Greece, operating mainly in the private sector and with the objective of filling the large gaps in public provision of LTC beds, as well as addressing the lack of effective public supervision of quality of services.

Licensing of care homes is granted by the Municipality Social Services department and since 2007 has been based solely on structural and staffing criteria, with no reference to criteria relating to the quality of care or quality of life of the residents. Membership of PEMFI thus enables a clear distinction to be made between legally operating units and the many illegal facilities available, but also aims to achieve a standardisation of quality in services provided through the voluntary adoption of quality standards, together with a harmonisation of costs, which translate as improved cost-benefit for the older residents and their families.

In response to the changing demographic situation (increasing life-expectancy, increased needs for care, reduced numbers of available informal family carers), PEMFI addresses the gap between the traditional Greek family-based approach to the care of older people and the trend towards alternative forms of care, due to the increasing inability of families to perform this role.

The immediate target group of PEMFI is the directors of residential care facilities, currently 120, but with the steady recruitment of new members, whose acceptance is dependent primarily upon the granting of a valid operation license by the prefecture. The indirect target groups are the staff and clients of the units i.e. older people with long-term care needs and their families (focusing on the specific needs of Alzheimer sufferers).

Description

PEMFI is the Hellenic union representing all legal care homes in Greece, founded in 1974 and re-organised in 2005, with a current total of 120 member-units and a capacity of up to 10,000 beds, providing residential care and nursing facilities for older people with higher levels of long-term care needs. The care homes’ staff consist of social workers, registered nurses, care assistants and associated personnel, including doctors, psychologists, ergotherapists, physiotherapists and gymnastic instructors. The aim is to provide high quality, relatively affordable services, tailored to individual needs and encouraging the active participation of family members.

The union was founded by the directors of care homes with the aims of:

• Developing standards in quality of care and quality of life related to improvements in 3 areas: living facilities; residents’ individual and common needs; staff recruitment, retention and active support
• Promoting and implementing specialised staff education, training and certification programmes and participation in research projects
• The development and implementation of new types of services and technologies for the older residents, e.g. electronic records, new methods of treatment and management of the problems of Alzheimer patients and their families, use of Skype both for professional communication and social contacts
• Participation in the European Association for Directors of Residential Care Homes for the Elderly – E.D.E.
• Developing financial models
• Lobbying for policy development in the field of residential care
• Negotiations with public health and social insurance funds to ensure their partial contribution to the residents’ expenses (currently only 2 funds – TSAY and SMEDE – participate)

Major achievements have been the successful use of new communication technologies and approaches to the management of residents’ care needs, e.g. electronic case records, care contracts, newsletters and websites with information and easy communication with the care homes, active encouragement of relatives’ participation in daily activities and special events. Continuing education includes:

• Specialised staff training in the problems of residents with Alzheimer’s disease and their families and the implementation of programmes of intervention and management
• Vocational training and certification of care staff
• Training in first aid provision, health and safety for unskilled personnel
• Training of informal carers

What are/were the effects?

PEMFI works closely with the relevant authorities, including the Ministry of Health and Social Solidarity, on issues of quality standards and cost sharing and was involved as a stakeholder in the design and implementation of the current legal framework for existing and newly licensed care homes. During the negotiations, PEMFI’s proposals on staff/resident ratio, professional specialties, training and buildings’ specification were taken into account. Additionally, PEMFI worked with the Ministry to seek acceptable solutions for the numerous unlicensed units, which involved using less rigid building and facilities criteria, in order to achieve legalisation and subsequent progress towards conformity in care quality standards.

Two of PEMFI’s member-units have successfully participated in piloting the ECVC programme of training and certification of care personnel and will continue to use the system. Through additional training seminars and participation in conferences, PEMFI actively contributes to the further and continuing education of care facility managers, all staff and personnel. In collaboration with the Department of Sociology, National School of Public Health, Athens, PEMFI participated in a qualitative research study (2008-2009) evaluating the satisfaction of relatives with the quality of services provided in seven care homes. This showed a high level of satisfaction with the general services provided (meals, facilities, resident’s personal hygiene, behaviour, knowledge and practice of the staff), whereas the design and implementation of activation programmes (recreational activities, extra-institutional events, gymnastics etc) scored lower in satisfaction. Additional findings were a ‘sense of relief’ by the relatives that their loved ones were in safe hands and a low percentage of respondents suspecting personal abuse.

Finally, PEMFI is working to change the image of Greek care units as places where older people are ‘abandoned’ by their families and transform it into one where care units are viewed as specialised settings for the provision of quality care and services, in collaboration with family members.

What are the strengths and limitations?

Strengths

• The 2005 reorganisation resulted in a new vision and function for PEMFI; the voluntary collaboration between legally registered care homes transformed the focus of residential care provision from primarily profit-based to one based on care quality and quality of life. 
• The encouragement of the active participation of informal carers in planning and carrying out daily activities, as well as the participation of other family members and local community groups (e.g. KAPI ) in the regular social events, contributes to maintaining links with the family and wider community. 

Weaknesses

• PEMFI has not yet implemented a system of regular quality evaluation and monitoring, which would help to promote good practice. 

Opportunities

• Despite the traditionally negative approach to residential care in Greece, combined with the lack of public residential care places, demographic changes are pushing for the expansion of this sector. PEMFI’s attempts to promote quality and professional care standards (e.g. conforming to recommended resident/trained staff ratios, high level of staff retention, training and certification of staff), while standardising costs, are already positively changing the sector’s image. 
• The large unlicensed/illegal residential care sector, consisting mainly of facilities licensed as ‘hotels’, with low levels of (mainly untrained) staff, offering cheaper but poor quality services, is a main target for expanding PEMFI’s membership by upgrading their services and legalising the facilities.

Threats

• During the present financial crisis, the voluntary basis of collaboration could threaten PEMFI’s continued efforts to promote better quality in LTC. Admissions to private residential care homes are likely to decline due to the inability of older people’s and family resources to meet the costs of care during times of economic stringency; there are indications that this is already happening.

Credits

Links to other INTERLINKS practice examples

• Geriatric Network and Geriatric Academy Brandenburg
• The E-Qalin quality management system

External Links and References

• PEMFI 
• AKTIOS 
• E.D.E - European Association for Directors and Providers of Long-Term Care Services for the Elderly
• Boufou, E. (2009) Private Elderly Care Units in Greece: Satisfaction of relatives with the quality of services provided. Athens: Dept. of Sociology, National School of Public Health (Unpublished study in Greek – abstract available in English).