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Rundum Zuhause betreut

Home Care Europe Conference

Caritas Vienna

Irene Pichler

Vienna, 4th of June 2009


Points of Departure

High number (no exact estimates) of „illegal“ migrant health care workers in Austria to deliver home-care-services for persons in need of care

Changing patterns of care: reduction of traditional care of relatives, people wish to stay at home as long as possible

New laws passed in 2007 to legalise home-assistance workers

„Hausbetreuungsgesetz“ (home assistance law) entered into force in July 2007

Changes to the Trade Commerce and Industry Regulation Act regulates the self-employment of home-assistance workers

„Legalisation“ of „illegal“ migrant health care workers in Austria transition to legal service of 24/7-home-assistance

End of the „amnesty“ by the end of June 2008


Self employed legal Home-Assistance Workers (HAW)

Two legal possibilities: regular employment and self-employment

Most of the new legal HAW are self-employed (employment too complicated)

Necessary to have a trade licence (unregulated trade)

Two-week rotation (2-3 months for Romanians/Bulgarians)

Origin of neighbourghing and other EU-states

Qualification requirements: Caritas - at least the qualification as a home-assistance worker (about 200hours) – since 2009 there is a new requirement for public funding of 24/7-home-assistence

Contractuelle Situation: 1 -„Service-contract“ between the placement agency and the client

2 - „Home assistance contract“ between the person in need/relatives and HAW that defines the precise activities monthly payment, social insurance and self employed taxation


Contractuelle Situation

Caritas

Home-assistance workers

Person in need of care

„Home-assistance contract“

„Service-

contract“

PlacementAgencies

(Partially highrecruiting-fees)


Services provided by the legal Home-Assistance Workers

Services rendered for people in need of care include the following „home-assistance activities“ (vs. medical care) f. e.:

Support activities in the household (such as cooking, making purchases, etc.)

Support regarding the organisation of daily activities To assure social interaction for the person in need of care Preparation for changes in residence Organisation of home assistance activities Support in feeding, hydration and prescription medicine, personal

hygiene, support in dressing/disrobing etc. unless medical reasons necessitate a written order („Delegation“)

Includes single medical care activities if delegated by physicians or nurses


Caritas‘ offer of 24/7-Home-Assistance

Service has been offered by the Caritas non-profit association Rundum Zuhause betreut since 2007

Within the non profit association five Caritas dioceses (Caritas of Vienna, St. Pölten, Linz, Salzburg und Graz-Seckau) are working together

This service is offered in five Federal States in Austria: Vienna, Lower und Upper Austria, Salzburg, and Styria

Cooperation with placement agencies regarding the recruitment of HAW (mainly in Slowakia)

„Legalisation Project in 2008“ in cooperation with other Austrian NGOs on behalf of the Austrian Ministry of labour and Social Affairs: information and consulting regarding legalisation


Key Services rendered by Caritas

Information and consulting for Austrian families regarding the legal service of 24/7-home-assistance

Care assessment (requirements, health situation, activities)

Recruitment of legal home-assistance workers, check of qualification requirements and knowledge of German as well as occupational aptitude / motivation

„Legalisation“ („ business or trade registration“)

Quality management: check through regular „quality visits“

Administrative support for families and HAW (regarding social insurance, business/trade registration, etc.)

Mediation and support activities in conflict situations


Caritas Quality Assurance

1 – Home visit by nursing staff

Checklist for the home visit: Personal data, assessment of care needs and existing care assistance-network decision if this service is appropriate

2 - Regular quality assurance visits by the nursing staff of Mobile Home Care Services (Caritas Mobile Dienste):

Checklist for the quality assurance visit: assessment of: - customer satisfaction, - competence of the HAW, - evaluation of changes in care needs and the care assistance-network, - suggestions for improvement

If necessary mobile home care services or a written order (“Delegation“) is provided


Written order „Delegation“ for medical care activities

In April 08 a new law was passed dealing with „Delegation/Subdelegation“ of medical care, diagnostisc and therapeutic activities (GuKG §§3b,§15)

Regulates that single medical care activities needs to be delegated by physicians or nurses

Development of procedures / documentation forms by Caritas

Training of Caritas employee in these procedures

Information and consulting are given to the client during the home visit

Control during the regular quality assurance visits


Services in Detail – Client Perspective

„First home visit“ to assess needs in care und home assistance activities, decides on the admission to the 24/7-home assistance service

Regular quality assurance visits by the nursing staff of the „Sozialstationen“ / regional bodies of the associated dioceses

Recruitment of „qualified“ HAW

„Legalization“ and administrative support regarding social insurance, registration of a business/trade

Continuous contact in the case of conflicts


Services in Detail from theHAW`s Perspective

Recruitment activities for self-employed HAW instead of own acquisition activitites, organisational support and strong bond to the organisation

Check of qualification, legal requirements and German knowledge

„Legalization“ - support activities regarding the registration of the business /trade, Caritas/NGO serves as a clearing house for HAW

Further administrative support regarding social insurance regulations, etc.

Regular quality assurance visits by the nursing staff of the „Sozialstationen“ / regional bodies of the associated dioceses: Support as well suggestions for improvement / competence of the HAW

Contact by native-speaking team members in case of conflicts


Costs of 24/7- Home Assistance

1- „Service-contract“ between the placement agency and the client:

Amount for placement and home visit: € 970,- (2 HAW)

Monthly charge: € 155,-

2 - „Home assistance-contract“ from 65€ to 75€ / per day plus travel expenses; room and board must be provided

Public financing of 24/7-home care: € 550,-/per month recoverable after the 3rd level of long-term care benefits (federal system)

Sample calculation: 30 days x 65 = 1950,- + € 160,- travel expenses + 155,- Caritas € 2265,-/per month


Results / Status Quo 2009

High level of interest in the new legal services from Austrian families less focus on legalisation of „illegal“ HAW

Caritas: about 130 active clients in five Federal States

More than 260 HAW in the labour pool

Regional focus: Vienna / Lower Austria

Countries of origin: about 95% Slovakia (Czeck Republic, Hungary, Romania)

Development of wellcome-folders for clients as well as bi-lingual folder and introductory sessions for HAW


Experiences / Challenges

Heavy financial burden for Austrian families already at the limit

Recruitment of „qualified“ home-assistance workers with good knowledge of German and social competence

Lack of entrepreneurial competences / entrepreneurship of HAW

Significant administrative, language and social barrieres; lack of legal information (f. e. on HAW`activities) etc.

Necessity to cooperate with private placement agencies

High expectations of the persons in need /relatives

High potential for conflicts


Prospects

Need to promote entrepreneurial competence /improvement of language knowledge /ability

Need for accompanying/advising structures for self employed HAW

Improvement of support / information / further training for HAW (partially excessive demands f. e. dementia)

Differentiation of the service: short-term 24/7-assistance (f. e. relief of the burden on the families), service after hospitalisation

Quality assurance: continuous improvement of quality / quality assurance of the new legal service

New qualification requirements for public funding of 24/7-home-assistance (at least 168 hours theory plus first aid training)


Thank you !

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