socially investing in older people – reablement as a social care policy response?

Socially investing in older people – Reablement as a

social care policy response?

Public pre-seminar: Tackling Inequalities with Social Investment Policies

Tine Rostgaard Professor

KORA – Danish Institute for Local and Regional Government Research

[email protected]

Why social investment? New risks in the post-industrial societyDespite overall increase in social expenditure ->Visibly larger income inequalities in the 1980s and

1990s; increase in child poverty and in ‘working poor’.Also increasing health inequalitiesProspect of even larger demographic challenges (fewer

children, more older people)Electorate supporting left-wing/social-democratic

governments

Conclusion: Neo-liberal and conventional social policy ‘repair’ agenda has failed

EU Social investment packageSocial investment for children,

homelesness, health, active includion and long-term care

Feb 2013: László Andor, EU Commissioner for Employment, Social Affairs and Social Inclusion

01-05-23Tine Rostgaard 3

Ageing societies looming, “a ‘tsunami of geezers’ that threatens to suck the life out of Western economies with their health and welfare needs”. (Marshall & Katz, 2012: 230)

Across EU MS, expenditure for long-term care expected to increase from present average 1.8 % of GDP to 3.6% in 2060


New risks

New risks, new responsibilities…Sine 1960 new perspective on ageing:

active ageing

Movement against the negative myth of ageing associated with frailty, illness and dependency.

New perspective: New perspective: Older people as healthy, productive, independent and sexually active – if they so desire and invest in this


Old Man Not Dozing…

Old Woman Dozing by Nicolaes Maes (1656).

http://www.answers.com/topic/nicolaes-maes

EU response based on Active ageing strategy…and responsibilisation/Big society“We need to enable older people to make their

contribution to society, to rely more on themselves and to depend less on others and for this we need to create conditions that allow people to stay active as they grow older.

‘Active Ageing’ promises to be such an approach because it seeks to help older people to: remain longer in the labour market; contribute to society as volunteers and carers; remain as autonomous as possible for longer”.

(European Commission, 2011b: 14).


EU social investment and long-term careChallengeChallenge – ageing societies and underdeveloped long-term care

systems, increasing health inequalities ageing care work force, low status and payment care work, massive informal care (80% of all care provided), but also need for women in labour market and longer working lives.

Variation and diversity Variation and diversity - Large inequalities across MS in risk dispersion and in equality in access to services, in optimation of quality and efficiency.

Formal care solution recommended. Reablement as a common policy response?


ReablementStrategy of minimizing risk: Reablement increases “the possibility of raising the overall

quality of protection against long-term care risks’ (European Commission, 2013: 19).

Offers a way out of welfare state inertia with MS facing ageing societies

Based on MS innitiatives. EU as facilitator, e.g. in European Innovation Partnership on Active and Healthy Ageing

Municipalities in Denmark as best practise exambles. Since 2015, reablement written into the Danish legislation and a generic model developed


What is reablement?Regaining abilities: “services for people with poor physical or mental health to help

them accommodate their illness by learning or relearning the skills necessary for daily living” (Care Services Efficiency Delivery (CSED) Programme (2007), UK)

• Usually a short-term intervention (3-12 weeks) in the home, training daily funcitons in order to re-gain or maintain capacities

• Common areas of focus: dressing, using the stairs, washing and preparing meals. But also ex. of more holistic approach: social and physical capacity, e.g. in DK

• Multi-disciplinary approach, goal-oriented• Obligatory in DK, widespread in England, Norway, used in New Zealand,

Scotland, Australia and US (restorative care)• In DK 80% of OPs considered to have ‘potential’ for reablement. An expected

success rate of 60% in regards to self-sufficiency post-intervention


Potential?Paradigme shift? Paradigme shift? Anything new here? • Copying already implemented in care practises and

basic education principles of self-sufficiency and ‘help-to-selfhelp care’

• But potential as a basis for consistent cross-disciplinary understanding consistent cross-disciplinary understanding and cooperation and cooperation

• Staff can apply specific competencescompetences and perform a goal-oriented goal-oriented intervention. intervention. Potentially boosting work morale. boosting work morale.

• Provides a platform for user involvementuser involvement• General basis for societal change in attitude to ageingsocietal change in attitude to ageing

• But does it increase quality of life for user quality of life for user and ensure greater independance and control over daily life?

• Does it reduce the need for conventional care reduce the need for conventional care and thus reduce social reduce social costcost?


??

Convincing UK results based on RCT: suggest reduction in need for social care (63% with no need, 26% with reduced needs), and decrease in cost

But including start-up costs and health care costs, no significant difference in total cost


Evidence from Nordic countries -effects OPs and economic effect

Only one RCT study, in Norway (Tuntland et al, 2016)• User effects:

• Long-term effect (12 months): OPs more satisfied with functioning in daily activities

• Short-term (6 months): OPs self-perceived better functioning in daily activities and some improvement in physical functioning and health

• Most frail gain most = tackling inequalities in health?• Economic effect

• Extra costs associated and initially post-intervention reduction in costs for home care, but then levelling out and same cost for health care = no economic effect

• Results from Danish RCT study (health, care related quality of life and loneliness in 2018 and economic effect in 2020 (Rostgaard et al)


Effects for home care workersEffects for home care workers:

• More likely to find care work rewarding

• Less likely to wanting to quit job

• Find that they receive support from manager

• Find to a greater degree that OPs needs are met

• Analysis of Danish data, NORDCARE survey, 2015/2016

• (Rostgaard et al, forthcoming)


More rare or never

Every month

Every day

Everyday

Several times a week

Sometime/rarely/neverYes, often

Sweden Finland Norway Denmark

Continued service universalism?Across Nordic countries targeting and re-definition of needs and services

Black: residential care; Green: home care

Source: Szebehely, under work

Ex: One municipality in DK decided in 2016 only to award cleaning services if the OP was blind, lame or heavily demented

Unresolved issues in a silent LTC revolution

• Which reablement models reablement models are most cost-effective and work best for the individual user?

• Which user groups user groups gain most from reablement? Dementia, chronic needs. Inclusion/exclusion

• Hidden side-effects Hidden side-effects – isolation, loneliness, admission to hospital

• Effect on informal care informal care – contrary to EU goal to increase womens LMP

• ScepticismScepticism – aim of cost reduction or better services leading to higher quality of life?

• Social investmentSocial investment or responsibilisationresponsibilisation?


Thank you!


socially investing in older people – reablement as a social care policy response?

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