2012年-CEPS欧洲政策研究中心_The_System_of_Long_22页_185kb

Summary of the Long-Term Care System in the Czech Republic

Core Content

The long-term care (LTC) system in the Czech Republic is structured across two main sectors: the health care system and the social services system. It is not considered a unified sector but rather a combination of services provided within these systems. The system emphasizes family-based care and aims to support the social activation of the elderly and disabled. LTC services include both institutional and home-based care, with a significant portion of care being provided informally by family members.

Main Views and Key Information

1. Overview of the LTC System

• LTC in the Czech Republic is not a separate sector but integrated within the health and social sectors.
• The system provides a wide range of health and social services to those who are not self-sufficient, including the elderly, disabled, and individuals with chronic illnesses.
• The philosophy of LTC is to provide care in a natural, home environment.
• The principles of accessibility, quality, and fiscal tenacity guide the LTC system, reflecting EU policy.
• Family care is the primary form of LTC, with approximately 80% of care provided by family members, mostly children or spouses.
• 66% of the population believes family care is the best option for the elderly.

2. Assessment of Needs

• LTC eligibility is based on health insurance coverage (health sector) or citizenship (social sector).
• The need for LTC is assessed by medical doctors in the health sector and social workers in the social sector.
• Four levels of dependency in daily activities (ADL) determine eligibility for cash benefits:
  • Light dependency: 12/36 activities (adults) or 5/5 activities (children) not performed.
  • Medium dependency: 18/36 activities (adults) or 10/5 activities (children) not performed.
  • Heavy dependency: 24/36 activities (adults) or 15/5 activities (children) not performed.
  • Very heavy dependency: 30/36 activities (adults) or 20/5 activities (children) not performed.
• The care allowance is provided to individuals who need assistance with personal care and basic social activities, and it is not considered income for tax or other social benefits.

3. Available LTC Services

• Health care system: Provides institutional LTC services such as aftercare, rehabilitation, and nursing in hospitals and LTC homes (LDN). It also includes home nursing care.
• Social services system: Offers pensioners’ homes, day/week care centers, and home-based services (in cash and in kind).
• In-kind services include personal assistance (shopping, meals, cleaning, etc.).
• Cash benefits are provided to individuals in need of personal care, typically by family members, and are used to cover care costs.

4. Management and Organization

• Residential LTC homes are managed by hospitals, regional and local governments, and the Ministry of Health.
• Social services are managed by the Ministry of Labour and Social Affairs, with implementation at the local level.
• Responsibilities are divided as follows:
  • Ministry of Health and Labour and Social Affairs: Policy development, funding, quality standards.
  • Regional and local governments: Needs assessment, service provision, monitoring and control.
• Non-governmental organizations (NGOs) play a role in providing social services, but face challenges with funding and contract procedures.
• The Ministry of Labour and Social Affairs has proposed quality standards, but these are general and require further development by service providers.

5. Integration of LTC

• Client Perspective: Integration of LTC services was low before the 2006 Social Services Act, which allowed for combined financing and independent client choice.
• System Integration: There is no unified system between health care and social services, leading to fragmented management and funding.
• Data Collection: Due to the lack of integration, data collection is dispersed, making it difficult to compile comprehensive statistics on LTC.

Funding

• Health care sector: LTC services for the severely ill are funded by health insurance.
• Social services sector: LTC services are funded through general taxes, regional and municipal budgets, client contributions, and public health insurance.
• Client co-payment: Up to 85% of an individual’s income can be used for co-payment.
• Funding Sources:
  • Client contributions: 35%
  • State budget: 30%
  • Local authorities: 25%
  • Health insurance: 3%

Demand and Supply

3.1 The Need for LTC

• The elderly population (aged 65+) is expected to increase significantly, from 14.4% in 2007 to 33.4% by 2060.
• The very old (aged 80+) are projected to rise from 3.3% to 13.4% in the same period.
• The old age dependency ratio is expected to increase from 22.2% in 2007 to 35.7% by 2030 and 60% by 2060.

3.2 Role of Informal and Formal Care

• The LTC system is oriented towards community-based services.
• Informal care (family-based) is the dominant form, with 80% of care provided by family members.
• Formal care includes institutional and home-based services, with the latter being more developed.
• The system encourages the use of cash benefits to support informal care, especially for those with limited ADL.

3.3 Demand and Supply of Informal Care

• There is no systematic research on the demand and supply of informal care.
• It is estimated that 400–500,000 informal care providers exist in the Czech Republic.
• Most care providers are women of working age, with 80% having full-time jobs.
• The system supports informal care through care allowances and cash benefits.

3.4 Demand and Supply of Formal Care

• Institutional care: The number of LTC institutions has remained stable, but the number of beds has increased by 16%.
• Home care: The number of home care agencies has grown, but there is a lack of adequately trained staff.
• Semi-institutional care: Includes boarding homes for pensioners, which are managed by local authorities.

LTC Policy

• Policy Goals: Promote social activation of the elderly, support community-based care, and ensure accessibility and quality.
• Integration Policy: The 2006 Social Services Act introduced the possibility of combining financing from both health and social sectors.
• Recent Reforms: The reform of 2006 shifted the focus from caregivers to care recipients.
• Current Debate: There is a need for better integration, stricter quality control, and more research on informal care.

Conclusion

The Czech Republic's LTC system is a blend of health and social services, with a strong emphasis on family-based care. While there have been some reforms to improve integration and support for informal caregivers, the system remains fragmented, with separate funding and management structures for health and social care. The increasing elderly population and aging demographic profile highlight the growing need for LTC services, especially in the social sector. Further integration and investment in staff training are essential for the sustainability and effectiveness of the LTC system.