2015年-CEPS欧洲政策研究中心_Quality_Assurance_Policies_and_Indicators_for_Long_10页_276kb

Quality Assurance Policies and Indicators for Long-Term Care in Poland (ENEPRI Research Report No. 109)

Core Content

This report provides an analysis of the quality assurance policies and indicators for long-term care (LTC) in Poland, focusing on the legal framework, institutional responsibilities, and current standards in both the health and social sectors.

Main Points

1. Institutions Responsible for Quality

• Health Sector:
  • The Chief Sanitary Inspectorate conducts regular inspections and publishes results.
  • The National Insurance Fund (ZUS) is responsible for contracting LTC services and setting standards.
  • The Patients' Rights Ombudsman investigates complaints and ensures rights are upheld.
• Social Sector:
  • Municipalities assess the provision and access to LTC services.
  • The Supreme Audit Office (NIK) audits public units, including LTC facilities.
  • The Ministry of Labour and Social Affairs defines standards for social assistance homes.

2. Legislation on LTC Quality

• Health Sector:
  • Act on Health Sector Units (1991)
  • Regulation on Access to Institutional LTC (1998)
  • Law on Health Care Services Financed from Public Sources (2004)
  • Law on Nurse and Midwife Occupations (2007)
  • Regulation on Guaranteed Nursing and Care Services (2009)
• Social Sector:
  • Act on Social Assistance (2004, amended in 2006 and 2011)
  • Regulation on Residential Social-Assistance Homes (2005)
  • Act on Revenues of Territorial Self-Government Units (2003)

3. Standards

• Staffing Ratios:
  • LTC nurses: 0.4 personnel per patient
  • Medical workers: 0.5 personnel per patient
• Home-Based LTC:
  • Environmental nurses provide care for at least 1.5 hours per day, four times a week.
• Residential LTC:
  • Bedrooms should accommodate up to three persons, with minimum sizes of 9 m² for single rooms and 6 m² per person for double/triple rooms.
  • At least one living room, bathroom for up to five persons, toilet for up to four persons, and additional room for laundry.
  • Minimum of three meals per day, with a four-hour interval between meals and availability of snacks.
  • Daily cleaning of rooms with appropriate detergents.
• Informal LTC:
  • No standards or regulations are in place to ensure quality or support informal carers.

4. General Assessment of LTC Quality System

• Effectiveness: LTC is relatively inexpensive due to informal care and strict control of formal services. The quality of LTC is slowly improving, as indicated by the results of the Supreme Audit Office.
• Safety: Safety is ensured through professional and sanitary standards, with annual reports confirming effective supervision.
• Responsiveness: The LTC system is perceived as closed and difficult to access due to strict control and limited availability.
• Coordination: There is a lack of coordination between the health and social sectors, which is a significant weakness in the system.

Key Information

• LTC Standards: Not well-defined or systematically monitored across the country.
• Quality Certificates: Not mandatory for LTC institutions, though some private facilities may pursue them voluntarily.
• Informal Care: Constitutes a major part of LTC in Poland, yet no quality assurance strategies or regulations exist for it.
• Adaptation Period: Social LTC institutions had a ten-year period to adapt to new standards, which was later extended by five years due to financial constraints.

Conclusions

• The LTC quality assurance system in Poland is fragmented, with responsibilities spread across multiple institutions and legal acts.
• While some efforts are being made to improve LTC standards and quality, the lack of coordination, monitoring, and specific indicators remains a critical issue.
• Informal LTC is particularly under-supported, with no established strategies to ensure quality or support carers.
• The system is generally seen as ineffective and inaccessible, especially for the elderly, with a preference for admitting individuals with mental disorders over the elderly in social LTC facilities.

Work Package Context

This report is part of Work Package 5 of the ANCIEN project, which aims to evaluate the future of LTC in Europe. The project is funded by the European Commission under FP7 and involves 20 partners across EU member states. It focuses on analyzing LTC needs, supply, use, and quality assurance, and projecting future scenarios based on demographic, epidemiological, and econometric models.

Summary of Project Objectives

• To assess the development of LTC needs, demand, supply, and use.
• To evaluate the performance of different LTC systems in Europe.
• To identify strengths, weaknesses, opportunities, and threats in LTC quality assurance policies.

Final Outcome

The report provides a comprehensive overview of the LTC quality system in Poland, highlighting the lack of unified standards, poor coordination, and the challenges faced by both formal and informal LTC sectors. It serves as a basis for further analysis and policy development within the ANCIEN project.