Organisational Structures
Formal Care in the Home and Community
multi-professional teams (eg preventive/rehabilitative measures)
COUNTRY / LOCATION: Greece
Keywords: Home care, home help, labour market
Keywords: Home care, home help, labour market
Help-at-Home
Summary
The Help-at-Home service is provided nationwide at the local municipality level, by multi-disciplinary care teams (social worker, nurse, family assistant/s), within the client’s home. The teams work autonomously and across organisations, in cooperation with other health and social care structures. The service was developed in order to help older people with LTC needs to stay at home with a good quality of life and initially focused on meeting the needs of socially isolated older people of low income and without family support. The programme was subsequently extended to allow family carers to work outside the home; it also aimed at the creation of new jobs in the care sector, especially for women in rural areas.
The service provides post-discharge, preventive and rehabilitative care, reduces unnecessary visits to hospital and other health care facilities and replaces or supplements informal family support.
What is the main benefit for people in need of care and/or carers?
Help-at-Home enables older people with LTC needs, to stay at home with a good quality of life and initially focused on meeting the needs of socially isolated older people of low income and without family support.
By providing day-time care and supervision of older people at home, the service frees family carers to enter the labour market.
What is the main message for practice and/or policy in relation to this sub-theme?
Small, flexible, multi-professional teams working with other related professionals, enable older people with long-term care needs to retain their autonomy, through the provision of essential support at home.
New jobs, mainly for women, have been created in the care sector at a relatively affordable cost to the municipalities and with no cost to the user.
Why was this example implemented?
Help-at-Home was initiated by the Greek Ministry of Health and Social Solidarity and further developed by the Ministry of Labour and Social Protection for three main reasons:
- To provide care to disabled and bedridden mainly older people, enabling them to stay in their own homes for as long as possible
- To release the family members, mainly women, from the role of the informal carer in order to enter the labour force
- To create new jobs in the labour market, mainly for women (social workers, nurses, family assistants), in line with the Lisbon agenda.
Help-at-Home is the only public service provided that offers pre-hospital care, post-discharge care, prevention, monitoring and support of frail older people and of the informal family help. It addresses the gaps in care between the health sector and the other available alternatives for older people with long-term care needs (see impact below).
The Help-at-Home programme supports partially independent disabled and older people and those with mobility dysfunctions and special problems; priority is given to those who live alone, or do not have the full support of their family, or their income does not permit them to pay for similar services to enable them to live at home with a reasonable quality of life. The programme providescounselling and psychological support, nursing care, family assistance and companionship.
Description
The example was initiated by the Ministry of Health and Social Solidarity and subsequently expanded and promoted by the Ministry of Labour and Social Protection, via the local authorities/ municipalities and is funded by EU social programs. It started as a pilot programme in 1998 in two neighbourhoods and has since been extended nationwide, under the responsibility of the municipalities.
The programme involves specialised, well-organised, multi-disciplinary teams of three individuals per unit, which comprise a social worker, nurse and a family assistant, with the support of a doctor or physiotherapist where necessary.
The social worker is responsible for the assessment and acceptance into the programme of the beneficiaries, evaluates the client’s situation and needs, provides advice and social support and maintains contact with competent agencies, making referrals where needed.
The programme's nurse conducts home visits in order to give preventive advice, undertake a physiological assessment, give personal care, write pharmaceutical prescriptions and escort the individual to the health centre or hospital for specific examinations. She/he also undertakes the “training” of family members in basic care procedures and supports the family.
The programme's family assistant is responsible for undertaking various duties such as cooking, shopping and cleaning the individual's home. Family assistants also offer an additional service, which is probably the most important in the eyes of these individuals, namely, companionship, which illustrates the programme's social nature.
Τhe service is provided currently free to the recipients of care and the cost is covered by national and European funds in the proportion of 75% EU funding and 25% national funding, although more permanent funding sources are being sought.
In 2010 the service consisted of about 1,050 teams running in most municipalities (i.e. over 90% of total coverage), employed 5,000 staff serving over 100,000 beneficiaries, with an annual cost of €35.76 million.
500 cars for staff for the mobile units have already been offered and 120 more are going to be provided by the Ministry of Health.
What are/were the effects?
Although the service is not developed or running for as long as it is in other European countries (DK, AU, UK, FR), the 2002 and 2006-2008 evaluation of the program has shown the targets were met with low cost, providing services unique for their kind, by mostly helping people with low income and without family support. It has created new jobs, mainly for women (social workers, nurses, non-skilled home assistants). Issues relating to prevention of hospitalisation, prevention of disability and rehabilitation were not examined. Additionally, it was estimated that from an average of 3.6 families using the service, one informal carer has been able to return to the workforce. During the informal carer’s working hours, the homecare team undertakes all practical care needed, so that care is shared between the formal and informal sector. Thus the programme is highly acceptable to the recipients, and apart from the continued job-insecurity due to unreliable sources of funding, there is high reported job-satisfaction amongst the care personnel.
This programme addresses the gaps in care between the health sector and other alternatives for older people with long-term care needs, namely moving to be near or live with their families, moving to expensive residential care, or employing a private assistant (usually a migrant live-in worker), with no supervision, usually untrained and with no contract or social security benefits.
What are the strengths and limitations?
Strengths
- An essential programme for out-of-hospital care at home, consisting of a core of highly autonomous professionals (social worker, nurse, family assistants) who act both flexibly and in integration with the local primary health care and other services (e.g. transport, voluntary agencies), as well as liaising with hospitals.
Weaknesses
- The continuation of funding is still not assured: Local Authority services are statutorily free to the user, so the solution of providing subsidised services (with user co-payment) is not available under the current regulations, although this may change under the new re-organisation of the municipalities.
- The service does not provide 24/7 cover i.e. the working hours are 9.00-16.00 weekdays only.
Opportunities
- There are plans for the continuation of the programme for the future. The broadening of municipalities under the ”Kallikratis” project, the popularity of the service, plus the opening to private care providers, despite the potential cost for the user, provide good possibilities for ensuring the future viability of the program.
Threats
- The main threat to the programme is the insufficiency of national funding. In order for the program to survive, the character of the service may change from a free-to-the-user public service, to a subsidised, not-for-profit or for-profit service.
Credits
Author: Georgios KagialarisReviewer 1: Marion Repetti
Reviewer 2: Kvetoslava Repkova
Verified by: Christos Kirkoglou
Links to other INTERLINKS practice examples
- As long as possible in one’s own life – sub-project: Home-rehabilitation
- Funding for home help for caregivers (CASTILLA Y LEON)
External Links and References
- Websites of NGOs (50plus Hellas)
- Municipality of Athens
- http://www.esfhellas.gr/english/articleList.aspx?iden=41 " target="_blank">EYSEKT
- Project presentation at the European Social Network Seminar, “Skills for care and inclusion: meeting the needs of dependent older people”, Athens, 11/05/2010.
