The region's administrational and legislative policies have always taken into account the increased demand for services for those reliant on care. Not only has there been an increase in the allocation of the regional budget, however, the organisation of the system has been reworked as well. In fact regional planning has confirmed that the integration of social and health care is an objective, along with the carrying out of its Local Area Plans. The best definition of regulations can be found in Article 124 of Regional Law LR 11/2001 which in defining its social services states: "Regione Veneto aims to integrate social services with health services in order to improve quality of life and the effectiveness of measures in order to maintain a state of wellbeing and prevent and remove causes of harm, disadvantage and illness. Regione Veneto protects health, in the widest meaning of the term, as a fundamental individual right which is in the interests of the community."
More recently, with the adoption of Regional Law LR 30/2009, the Regional fund for the non self-sufficient was introduced. This fund aims to guarantee a regional system of social and healthcare to those who are reliant on care, as well as to support care work by families.
The fund pools the resources of a previous fund that had been set up according to Article 3 of the 2008 Regional Financial Law, those allocated to a homecare fund by Article 26 of Regional Law LR 9/2005, those for alarm-call systems and remote surveillance, and the resources to finance day-centres for people with disabilities.
Contributions to the fund also come from the State or other public authorities from funding allocated to those reliant on care. To increase the sustainability of the services, Article 7 of Regional Law LR 30/2009 envisages other forms of revenue, including the introduction of a share of revenue from income tax. This has not yet been brought into effect.
This analysis focuses on policies for elderly dependent people. The assistance system provides both residential and home care.
Residential care
The most recent model for assistance to dependent persons who cannot be cared for at home is covered by Regional Government Decree DGR 751/2000. Following the reform of Italy's national health service, this completed the regional planning of residential homes offering health, medical, nursing and rehabilitation assistance.
The evolution of health policies means that admittance to hospital is only for critical phases of illnesses and follow-up treatment. The regional network of residential services deals with long-term treatment and lengthy rehabilitation. Health assistance that takes less than three hours is defined as "extensive". This is the kind of assistance that the structures in Veneto's non-hospital network deal with, outlined by Regional Government Decree DGR 51/2000 in three types of services characterised by medium levels of health assistance, known today as second-level care, and reduced and minimal care, today known as first-level care. There is one second-level place to every three first-level places.
This service was confirmed by Regional Government Decree DGR 464/2006, which updated regional planning of residential care. This also defined criteria for calculating the demand for care, a theoretical parameter which should be updated annually. It calculates the number of authorisations that can be assigned, as well as the number of bed places that can be authorised for each Local Health Authority. This number shows the relation between age groups and the care that can be provided in the area. In fact it is calculated by multiplying the age groups of inhabitants within each ULSS by the following coefficients:
- 0.06% for the population in the 0-64 age group;
- 0.65% (+0.5% for mountain areas (Note 3) and the Venetian islands) for the population in the 65-74 age group;
- 4.40% (+1% for mountain areas and the Venetian islands) for population in the 75 and over age group.
Demand has been calculated from 2007 onwards. For 2011 27,244 units have been estimated, a 12.8% increase in four years. (Figure 9.3.1)
Another new feature is the introduction of an authorisation for residential care
(Note 4), which the user is given to access residential and semi-residential care. This guarantees the users and their families more freedom of choice. The new plan also considers care in the Alzheimer's High Protection Section (SAPA), in services for users in a Persistent Vegetative State (PVS) and temporary respite care in residential homes.
The assignment of authorisations for residential care also depends on the availability of regional budget in relation to demand, calculated as seen above. The alignment of this parameter is gradual, as in the past the assignment of authorisations to the Local Health Authorities also took into account the number of bed places in each area. Therefore, for some ULSS the number of authorisations is higher than the average regional parameter, and in others is lower. New authorisations may be allocated to the Local Health Authorities with a lower than average number to bridge the gap with the regional average. This change can be seen in the following table, which does not show the transfer of authorisations from ULSS 14 to ULSS 16 following the implementation of Regional Law LR 22/2008 on 1 January 2010. This shifted nine municipalities in the Saccisica area from ULSS 14 to ULSS 16.
(Table 9.3.1)
For elderly dependent people in Veneto today there are 19,859 first-level care authorisations and 3,966 second-level care authorisations. Moreover there are 795 first-level places and 24 second-level places assigned to people of the Church who are not provided for by the residential care system and therefore not accounted for when calculating demand. There are 1,211 places in day-centres for the elderly, 150 for patients in the Alzheimer's High Protection Sections and 165 for those in a Persistent Vegetative State.
(Table 9.3.2)
The relation between the number of authorisations and demand is on average 87 authorisations per 100 units of demand. Thirteen Local Health Authorities have more places and eight have fewer.
(Figure 9.3.2)
Finally it is also important to consider the value of each authorisation for residential care, which together are defined as "healthcare shares". These are part of the value of the fee paid to the Local Health Authority for care in authorised residential homes, in relation to the type of service and the user's needs. They mainly cover expenses for care workers, nurses and social activities. The other part of the fee is the so-called "hotel share", which is paid directly by the user or by the municipality in some cases.
Authorisations for first- and second-level residential care account for most non-hospital residential care expenditure. From 2001 to 2010 their value rose respectively by 46%, from 33.57 euro to 49 euro, and by 54.9%, from 36.15 euro to 56 euro.
Multiplied by 365 days, the value per capita of a place in residential care in 2010 was 17,885 euro for first-level care and 20,440 euro for second-level care.
(Figure 9.3.3)
Home care
The importance of keeping elderly dependent people in their own home environment is receiving increasing recognition. Therefore for some years, regional policies have aimed to enable people to stay at home, while residential care is only used for people who have no other option. Even within the home environment it is necessary to guarantee the quality and appropriateness of services, as well as their accessibility and sustainability.
Policies supporting home care are divided into three areas, as outlined in Regional Government Decree DGR 39/2006, which defines the "Local Plan for Home Care". These are:
- services provided in the home to support the family, which must account for at least 20% of home care resources, i.e. social home care, health home care, including the supply of prostheses and aids, and integrated social and health care (SAD/ADI), alarm call systems and remote surveillance, services provided by the local community.
- financial support (at least 45% of the resources): care allowances (ADC) for the users and their families, which vary according to the type of care and the types of assistance provided ("basic" users, users with Alzheimer's, users with a live-in carer, and users with Alzheimer's and a live-in carer). Variations also depend on the user's equivalent financial situation indicator (ISEE), which must be lower than around 15,000 euro to be able to benefit.
- respite services for the family (at least 7% of the resources): temporary stays in residential care, holidays, etc. for dependent people.
In 2009 there were 18,270 equivalent care allowance users aged over 64, a figure obtained by rounding up the number of those who had used the service for less than 12 months to one year; a total of 15,808 people used the home care services. This latter figure refers not only to elderly users, but to the total number of users regardless of age. They are, however, mainly elderly users: around 88 out of 100 are aged 65 or over.
(Table 9.3.3)
As concerns services offered in the users' homes, Regional Government Decree DGR 39/2006 makes exclusive reference to social care services, which are provided by local authorities, and may be delegated to the ULSS as foreseen by the Local Area Plan. These services aim at prevention, maintainance and rehabilitation which will allow elderly dependent people to stay in their own home. They also offer support to their
caregivers. The services are provided directly by the municipality, unless otherwise delegated by the Local Health Authority, and usually include the supply of meals, home help, transport, psychological and social support.
Home care services that offer assistance directly to the elderly person with home visits and nursing staff are part of the basic levels of regional assistance
(Note 5). The objectives of these services depend both on the users and the human resources
(Note 6). As concerns the users, the aim is to offer care to at least 2% of over-65s. In 2009 the figure for Veneto was 1.62%.
(Figure 9.3.4)
As concerns the ratio between staff and users, the aim is to provide one worker
(Note 7) working full-time for 6 to 14 users. The regional average in 2009 was 9.8 users per worker, with a low of 2.3 users for ULSS 12 and a high of 57.9 for ULSS 7.
(Figure 9.3.5)
In 2009, 23,431 people were awarded a care allowance, also for a period of less than 12 months. There was the equivalent of 18,270 users, calculated as if all users had been awarded the allowance for exactly 12 months. Of these, 3,747 were awarded the highest allowance because they suffered from Alzheimer's or other forms of dementia leading to behavioural problems, 2,661 because they had a live-in carer, and 1,190 because they had both Alzheimer's and a live-in carer.
The average annual care allowance awarded was 2,822.41 euro; 4,527.44 euro for people with Alzheimer's; 3,257.27 euro for those with a live-in carer; 4,767.38 euro for those with Alzheimer's and a live-in carer; and an average of 1,898.50 euro for the remaining users.
There is also a coverage index for care allowance, which in any case is not an objective, as it does not require particular organisational resources. In 2009 there was an average of 1.87 equivalent users per 100 inhabitants aged 65 and over.
(Table 9.3.4)
Respite care was set up in experimental form by Regional Government Decree DGR 3960/2001, with the aim of introducing forms of support for members of the family providing care. These services, known as "good service" and "good respite" allow the families to put their loved ones in temporary care or to make use of extra services other than those provided by the home care service.
This form of support stems from the
need to respond rapidly to urgent requirements and is currently organised in different ways from one Local Health Authority to another, also depending on different regulations in Local Area Plans. It is therefore difficult to give an accurate analysis of its use.