A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands

Abstract

A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands As result of an increase in the numbers of frail elderly people, most European countries are facing problems with the financing and provision of services by nursing homes. At the same time, the expectations of quality of these services continue to rise. The main question investigated in this study was that of how countries approach the problems of financing and service provision by nursing homes and, at the same time, attempt to increase the quality levels in these institutions. The study was conducted in Belgium, Denmark, Germany and the Netherlands. A study was made of the relevant literature and questionnaires were sent to experts in each country. The four countries are addressing the problems of financing and sufficient service provision by controlling the use of nursing home services. In addition, financial problems are approached by extending co-payments, encouraging cheaper forms of care and putting pressure on nursing homes to operate at lower costs. Problems in the provision of care are addressed by applying more selective admission criteria and offering alternative forms of care outside the nursing home. As a result nursing home beds are used for those with the greatest care-dependency. Nursing home services are adjusted to rising quality expectations by offering a greater range of provision, decreasing the number of residents per room, improving comfort and improving the training of nursing staff. Another way to increase the quality of care is to separate the housing and service functions. Many nursing homes nowadays collaborate intensively with other facilities for the elderly to cope with all these problems and changes. The workload for nursing home staff has increased because of the increasing care-dependency of residents, the demand for higher quality of services and the financial problems.

The nursing home versus the hospital as the place of dying for nursing home residents in Japan

“…With the rapidly growing population of elderly, nursing homes play an important and expanding role not only in Western society [1][2][3], but also in Japan [4]. In 1999, 4.3% of those over 65 years old in the United States were living in nursing homes [5], while in 2003, 1.4% of those over 65 years old in Japan were living in nursing homes [6,7].…”

Toward a New Social Contract? The Participation of Civil Society in Swedish Welfare Policymaking, 1958–2012

“…Between 2002 and 2010, the share of employees in nonprofit organizations remained stable, from 4.3 to 4.5%, yet in FPOs increased from 6.8 to 12.7% (Hartman 2011, p. 23;Wijkström and Einarsson 2006). Although the share of private organizations operating as welfare service providers has remained lower in Sweden than in other countries (Meijer et al 2000), the above arguments and empirical evidence could indicate that the share of forprofit actors in welfare policymaking during the second half of the twentieth century increased.…”

Medical healthcare utilization as related to long-term care at home or in special accommodation

“…An increase in the number of older people in need of long-term care and services in combination with financial problems have forced many European countries to apply more restrictive eligibility criteria for beds in nursing homes (Meijer et al, 2000) which has resulted in more older people receiving care at home (Bergmark et al 2000). This trend towards home care might imply a risk of higher utilization of medical healthcare among those cared for at home since there are less professionals around the clock compared to the situation in nursing homes.…”