In Europe, the demand for long-term care for older people is growing and is set to increase exponentially in the coming years. Traditionally, meeting this demand has differed across Europe depending on cultural norms, whereby in some countries (Portugal, Ireland, Italy and Spain) families would care for older relatives, in others (France, Germany, the Netherlands and the UK) the State would step in and support. However, with families becoming smaller and people living longer, there have been significant changes in meeting the long-term care needs of older people and public authorities across Europe have sought to employ different models to ensure coverage, accessibility and sustainability.
Guaranteeing the right to quality long-term care for older people
UN Principles for Older Persons (the Madrid Declaration) supports the fundamental right of all people to remain integrated in and participate in society, calling for actions to support older people’s independence and autonomy and for services “to assist people to reach their optimum level of function”. This principle has lent itself in no small way to the paradigm shift of care provision for vulnerable groups in Europe over the last 20 to 30 years, particularly for older people.
In Europe, community care development strategies have focused not only on the human rights arguments for a transition from institutional or residential facilities to community based options, but also on the economic argument that overall outcomes for older people in community based care were more cost-effective than institutional/residential care. Therefore, the best care options offering the best quality of care, as per international and national standards, should be community based.
Providing quality care for older people
Quality care and its provision can be underpinned by a range of important principles. These include being person centred, availability, accessibility, affordability, comprehensiveness, continuity of care and being outcomes oriented. Whether providers or commissioners of services, public authorities should ensure that the provision of long-term care is anchored to the above principles.
Delivering support which enables older people with care needs to stay at home for as long as possible can assist greatly to improve their situation and quality of life. A key factor in improving quality of life is to have a broad range of integrated and coordinated support services available, including support for informal carers. This can be achieved through the development of national strategic frameworks and multidisciplinary approaches to assessments and care plan development as well as to an integrated delivery of health and social care for older persons with long-term support needs.
Not just quality of care, but quality of life
Quality care cannot be viewed as merely a means to an end. Commissioners of services, service providers and beneficiaries of care are insisting on a focus which also ensures quality of life.
The quality of one’s life can only be captured from the person’s perspective. It is about autonomy, social connection and personal meaning or purpose. This has implications for all stakeholders and underlines the importance of procuring and developing long-term care services based upon the needs but also the wants and assets of the beneficiary. Moreover, commissioners of services and providers will also have to ensure that services are person centred, focusing on the personal health and wellbeing of the beneficiary.
Shifting the paradigm
In conclusion, we have rightly shifted from medicalised and paternalistic models to those that place both quality of service and quality of life at the core. Yet governments are still struggling to provide sustainable and cost-effective services which embrace the pillars of the quality of service and quality of life model and remain overly dependent on the role of the family and community.
National strategic frameworks are required to promote an integrated and coordinated approach between different services and sector, particularly the health and social sectors. There also needs to be an overhaul of working conditions for care staff as they play the primary role in care delivery, and in building relationships with beneficiaries. In the end, no price can be placed on human dignity, compassion and meaning in a person’s life.
- 2010 Contracting for Quality: https://www.esn-eu.org/sites/default/files/publications/2010_Contracting_for_Quality_EN.pdf
- 2011 report on developing community care: https://www.esn-eu.org/sites/default/files/publications/2011_Developing_Community_Care_Exec_Summary_EN.pdf
- United Nations Principles for Older Persons, 1991; Political Declaration and Madrid International Plan of Action on Ageing, 2002