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Caring for older people at home

Since the last few decades life expectancy has risen across Europe and the proportion of elderly people in the general population has increased in the majority of countries and continues to rise further in the coming decades. Even if the speed of population aging is different from one country to another, Eurostat estimates that all countries are concerned and that, by 2060, the proportion of population aged 65 years and over would be more than 29% in average against 9,6% a hundred years before (Table 1). The percentage of the oldest-old (population aged 80 years and older) could even reach 11, 5% against only 1, 4 % in 1960 (Table 2). 

 Table 1: Percentage of population aged 65 years and over on 1 January of selected years

Source: Eurostat, population projections, table created with data from April 2011

 

Table 2: Percentage of population aged 80 years and over on 1 January of selected years

Source: Eurostat, population projections, table created with data from April 2011

These figures make clear that population ageing and its implications for the socioeconomic systems will be a major challenge for the European countries in the next 50 years.

Consequently, the increasing number of care-dependent elderly people increases also the need of home care. The term “home care” is used in different manner in the European countries. According to the EURHOMAP project[i], formal home care can be defined as “care provided by professional carers within clients’ own homes” and includes…

  • domestic aid services that are related to instrumental activities of daily living or IADL (for example using the telephone, shopping, housekeeping, food preparation, taking medication, financial administration…),
     
  • personal care services (for example assistance with dressing, toileting, washing, feeding, getting in or out of bed…),
  • supportive nursing (the provision of health information and education)
  •  technical nursing (for example assistance putting on prostheses or elastic stockings, skin care, disinfection and prevention of bedsores, oxygen administration, giving intravenous injections; changing stomas and urinal bags….)
  • and rehabilitative nursing (occupational therapy or physiotherapy)

Whereas, informal home care is given by family members, friends and volunteers who are normally not paid, and by non-professional carers who are paid informally.

The services listed above refer to social care or to health care. But the definition of these both systems can vary between the countries. For example, home nursing is normally seen as a part of the health care and domestic aid as a part of social care. But personal care services can be part of health or social care. Studies showed that there exist different systems of home care in the European countries. Within the framework of the EURHOMAP project, the Netherland health institute for health services research developed in cooperation with 9 other institutes a database to compare aspects of context, policy and regulation, financing, and organization and delivery of home care in 31 European countries (27 EU member states, Croatia, Iceland, Norway and Switzerland). You can find detailed information for each country in this database (http://www.nivel.nl/en/home-care/Country-information-on-home-care) and the report of the EURHOMAP study here: http://www.euro.who.int/__data/assets/pdf_file/0008/181799/e96757.pdf.

 

[i] EURHOMAP (Mapping professional home care in Europe) is a research funded project by the European Community under the Public Health Action Programme (2003-2008).